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Could there be a nerve root stroke? How to be treated if a spinal cord injury occurs? Causes and risk factors

Acute violation of cerebrospinal circulation is called, which occurs in one of three pathomorphological forms: ischemia, hemorrhage, or their combination. Spinal cord vascular diseases are much more popular than it might seem at first glance. While the brain to spinal cord mass ratio is roughly estimated at 47: 1 (an average of 1400 grams of the brain and 30 grams of the spinal cord), the ratio of the incidence of stroke to the brain and spinal cord is estimated at 4: 1.

Localization of the pathological process is established with difficulty, if we start from the idea that the spinal cord is supplied with blood through one anterior and two posterior spinal arteries.

The arterial system of the spinal cord of the upper parts of the cervical regions begins in the intracranial part of the vertebral arteries. Most of the spinal cord is supplied with arteries extending from the segmental branches of the aorta and approaching it together with the spinal roots, forming the aortic pool. The largest among the anterior radiculo-medullary arteries is called the "large anterior radiculo-medullary artery" or "Adamkevich's artery" (artery of the lumbar thickening).

Today in the medical community it is not accepted to consider the anterior spinal artery as an independent vessel; rather, it is considered as an anastomotic chain of descending and ascending branches of the radiculomedullary arteries. The same opinion applies to the posterior spinal arteries, although their number is noticeably larger and the diameter is smaller. The general system of blood supply to the spinal cord is estimated as a set of basins of the anterior and posterior radiculomedullary arteries located one above the other.

The clinical difficulty in identifying an artery affected by spinal bleeding is the variety of levels of entry into the spinal canal of such arteries. At the same time, the clinical thinking of a neurologist when examining a patient with various diseases of the spinal cord implies the verification of the site of possible occlusion of the vessel supplying the spinal cord along the existing blood flow from the aorta, along its segmental branches to the spinal cord.

Among the elderly (from 56 to 74 years old), senile (from 75 to 90 years old) and long-livers (over 90 years old), vascular diseases of the spinal cord develop with increasing frequency. Examinations of patients in these age groups confirm the presence of symptoms of dysfunction of the spinal cord. A wide variety of etiological and pathogenetic factors leads to dysfunction of the spinal cord:

  • by old age, more than half of the neurons undergo natural degeneration due to apoptosis;
  • and at a younger age, due to perinatal pathology of the nervous system (hypoxia, trauma, infection, etc.) or natural apoptosis, the initial number of neurons is reduced (degenerative and genetically determined diseases of the nervous system);
  • transferred neuroinfections, intoxication and various disorders of neuronal metabolism;
  • hypoxia of neurons is the most frequent and universal pathogenetic mechanism of the development of spinal bleeding;
    • congenital - malformations in the form of arteriovenous and arterial aneurysms, telangiectasia, angiomatosis, as well as stenosis (coarctation) and hypoplasia of the aorta;
    • acquired (atherosclerosis and its complications, less often vasculitis).

Clinical and clinical-anatomical studies show that atherosclerotic lesions of the vascular wall are most pronounced in the walls of the aorta and noticeably decrease in frequency and severity in the distal parts of the arterial network supplying the spinal cord. Atherosclerotic vascular changes are permanent, but clinical symptoms often have an intermittent course at first.

In almost every second patient, the disease begins with muscle wasting or fascicular twitching in both the arms and legs. It can all start with stiffness or weakness in the legs, less often with a feeling of numbness or paresthesia in the distal legs. Later, these initial symptoms, depending on the localization of the vascular process, develop with a predominance of signs of atrophic, spastic or mixed paresis.

It is advisable to highlight the following options for disorders of the cerebrospinal circulation:

  • initial manifestations usually occur during exercise (dosed walking, squatting, running, etc.) and in conditions of increased brain demand for blood flow to its individual areas; this is periodic fatigue, weakness in the limbs, a feeling of chilliness, crawling creeps, sweating, pain along the spine with irradiation for several minutes or hours; they disappear without a trace after rest;
  • transient disorders - acutely manifested symptoms of spinal cord dysfunction (paraparesis or plegia with or without sensitivity disorders, pelvic organ dysfunction), passing within 24 hours; occur with sudden movements, falls, intercurrent infections, intoxications; myelogenous intermittent claudication, segmental or conductive hyperesthesia, urge to urinate or urinary retention and stool.

It should be noted that in one third of patients, after repeated transient disturbances, complete normalization of the spinal cord function does not occur.

The clinical picture of chronic disorders of the cerebrospinal circulation is represented by a slowly progressive lesion of the spinal cord. With a slowly progressive ischemic lesion of the spinal cord with multi-segment necrotic decay of brain tissue, movement disorders can reach the stage of paralysis and patients are bedridden.

Despite the usually slow, gradual development of the disease, its acute onset with a further chronic course is not excluded. Often, the course of the disease remains stable for a long time, and death occurs as a result of cardiovascular, respiratory complications or from intercurrent diseases. Spinal cord pathology can occur from 2 to 25 years.

Ischemic spinal stroke is a sharp violation of the cerebrospinal circulation, which develops with its characteristic acute (up to a day) or subacute (from 2 to 5 days) course. In 2/3 of patients, the phase of precursors of spinal stroke can be distinguished:

  • transient weakness of the lower or upper extremities or myotome (paired rudiment of skeletal muscles in humans),
  • transient paresthesias and numbness in the dermatome zone or in the spinal conductor type,
  • transient dysfunction of the sphincters of the pelvic organs (incontinence of urine, feces, or, conversely, their delay).

Spinal cord infarction usually develops acutely, but the severity can vary from fulminant to several hours. Myeloinfarction is often accompanied by pain in the spine. This pain disappears soon after the development of para-anesthesia and paralysis. At the same time, in the first minutes of spinal cord ischemia, muscle twitching and trembling of the limbs develop. Reflex cerebral disorders are possible in the form of fainting, headache, nausea, general weakness. General cerebral symptoms usually pass quickly, while spinal symptoms remain pronounced and depend on the location of the infarction (tetraplegia, paraplegia, or myotomic paresis).

How is spinal stroke treated?

Spinal stroke treatment and other patients with disorders of cerebrospinal circulation is a stepwise therapy. Its nuances are determined depending on the variant of the clinical course.

Urgent measures must be taken in the acute phase of a spinal stroke. In cases of compression of the radiculomedullary arteries and large radicular veins by herniated intervertebral disc, urgent surgical intervention is required.

Patients often have to carry out surgical interventions with a temporary shutdown of the aorta or its large branches. It is in their process that the risk of developing myeloischemia increases. Regional infusion of chilled solution and adenosine phosphate is considered an excellent method to prevent postischemic spinal cord injury. A decrease in the consequences of myeloischemia occurs already when the spinal cord is cooled to 30 ° C, and deep cooling of the spinal cord to 22.8 ° C prevents paraplegia when the aorta is clipped for 45 minutes.

Carrying out modern surgical interventions involves the use of extracorporeal blood circulation, bypass grafting of the aorta and intercostal arteries, in case of their involvement in the spinal blood supply:

  • with arteriovenous malformations - carrying out endovascular interventions with embolization or balloonization of the aneurysm;
  • with myeloischemia of any genesis - the use of antioxidant drugs, serotonin antagonists, hyperbaric oxygenation, various physiotherapeutic procedures, spinal cord electrical stimulation, magnetic stimulation, magnetotherapy.

The systematic use of anti-sclerotic drugs, nootropics, and vitamins will also be an integral component of the treatment of spinal stroke. Regardless of the patient's age, it is recommended to carry out rehabilitation measures taking into account the state of the cardiovascular system and intellectual-mnestic functions.

What diseases can it be associated with

In clinical practice, cerebrospinal circulatory disorders are most common when the vessels supplying the spinal cord are squeezed:

  • compression of the abdominal aorta
    • pregnant uterus,
    • periaortic tumor,
    • tumor-like formation,
    • radiculo-medullary artery;
  • compression of the abdominal vein
    • herniated disc,
    • fragments of a spinal fracture, etc.

Almost all elderly patients have a competitive combination of vascular atherosclerosis and spondylogenic effects on them. Diabetes and alcohol intoxication often contribute to the development of vascular pathology.

Spinal circulation disorders are accompanied by such disorders:

  • paraparesis or plegias,
  • disorders of the pelvic organs
  • myelogenous intermittent claudication
  • hyperesthesia,
  • incontinence of urine and feces,
  • cerebral disorders - fainting, headache, nausea, general weakness.

Spinal stroke treatment at home

Spinal stroke treatment at home is unacceptable. In its acute phase, urgent measures are required.

Regardless of age, the patient should be hospitalized in a neurological unit or in an intensive care unit (preferred). In such conditions, under the supervision of specialists, with monitoring of vital signs, he is injected with antispasmodic and improving collateral circulation drugs, as well as drugs that improve microcirculation, anticoagulants, nootropics, antihypoxants, decongestants and drugs that improve cardiovascular and respiratory activity.

The prognosis for vascular lesions of the spinal cord depends on the etiological factor and the possibility of its timely elimination. In general, favorable outcomes of myeloischemia occur in about 70% of cases.

What are the drugs to treat a spinal stroke?

Medical treatment of spinal stroke is unlikely to be an independent method of therapy, usually it is an addition to surgery or is used at the stage of rehabilitation. Any medications are prescribed by the attending physician, and the dosage and duration of the course of use depend on the results of profile diagnostics and the stage of development of the pathology. An example of topical medications might be:

  • flunarizine - improves cerebral circulation and oxygen supply to the brain, relaxes the smooth muscles of the vessels; the therapeutic window and drug dosage correspond to the level of hypotension;
  • - being an antagonist of calcium ions, it is able to reduce the resistance of resistive arterioles of the brain and spinal cord, improve cerebral circulation and reduce hypoxic phenomena.

Spinal stroke treatment with alternative methods

The use of folk remedies for spinal stroke treatment should not occur, since this is an acute life-critical illness. The normalization of vital functions often requires surgical intervention, at least a professional approach to treatment, and not the use of alternative medicine.

Spinal stroke treatment during pregnancy

Spinal stroke during pregnancy is an extremely rare disorder, since it still happens in old and old age. A woman of reproductive age is threatened by this pathology in the presence of congenital or acquired pathologies listed above. All available methods of disease prevention are recommended. If it was not possible to avoid it, spinal stroke treatment is carried out according to a general strategy, taking into account the situation of women.

Which doctors should you contact if you have a spinal stroke

In the case of the development of circulatory disorders in the spinal cord and spinal stroke, magnetic resonance therapy and selective spinal angiography are of important diagnostic value. The latter allows you to determine all the details of the structure of vascular malformation. MRI is necessary to visualize the state of the spinal cord, to detect postischemic atrophy or hematomyelia.

The basis for performing selective spinal angiography is the presence of a symptom of an arterial shock... In the supine position of the patient, the doctor presses the abdominal aorta at the level of the navel on the left to the anterolateral surface of the spine. After the disappearance of the pulsation in the aorta, the pressure continues for 10-15 seconds, and during this period the patient develops pain of varying intensity in a certain area of \u200b\u200bthe spine or of a shooting character, radicular pain, which disappears soon after the cessation of compression of the aorta. In addition, patients often report paresthesias in the legs (numbness, tingling, vibration, coldness) and / or in the back.

The presence of a symptom of a venous push check also with the patient in the supine position. When the inferior vena cava is squeezed at the level of the navel on the right, local pain and / or conduction-segmental paresthesias in the lower half of the body occur. When the inferior vena cava is compressed to the anterolateral surface of the spine, venous outflow from the spinal canal becomes difficult, and in the presence of a vascular malformation, it increases in volume and clinically manifests itself. If no pain or paresthesia occurs during this time, the symptom is absent.

When a symptom of a venous impulse is detected, the patient needs selective spinal angiography or MRI with a vascular program to clarify the structure and localization of vascular malformation to determine the treatment tactics.

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Disruption of blood circulation in the spinal cord area can cause a spinal stroke. The disease is not directly related to the spine, the problem lies in the vessels, through which the spinal cord is nourished. Sudden, sharp back pain and muscle tone are the first signs of this condition. Over the next days, numbness of the legs, a change in their tactile sensations and severe weakness appear.

This condition is quite rare, among all kinds of stroke, the spinal one is gaining no more than 1%.

Clinical features

Spinal stroke has two types of its course - complete cessation of blood flow to the spinal cord (ischemic type) and rupture of a blood vessel, followed by hemorrhage (hemorrhagic subspecies).

If a spinal cord stroke is "located" in the cervical or upper thoracic region, then the complications are paralysis of the lower extremities, with all the ensuing consequences.

The reasons

The reasons that serve as the impetus for the occurrence of spinal stroke are a deficiency of substances that feed the spinal cord, caused by sclerotic changes in the vascular system and arteries.

Factors that lead to this condition:

  • tumor-like growths and herniated intervertebral discs - under their "weight" the vessels are compressed and, accordingly, the blood flow is disturbed;
  • surgical interventions in the spinal cord area, as well as the use of anesthesia;
  • mechanical injury to the aorta and spinal structure;
  • ischemic stroke with damage to brain tissue;
  • fractures of the vertebrae, with fragments or indentations of its parts;
  • enlargement of the lymph nodes, which are located in the peritoneum and chest;
  • punctures and other diagnostic procedures performed on the spine;
  • poor quality chiropractor procedures;
  • varicose blood vessels, a sharp drop in platelets, hemophilia;
  • diseases of the heart and vascular system, including myocardial infarction;
  • circulatory disorders due to inflammatory processes in the body.

Symptoms

Symptoms of a spinal stroke can be expressed in completely different ways, and this is the complexity of diagnosis, since this condition is often confused with other diseases - an inflammatory process in the kidneys, exacerbation of sciatica. The first acute pain and cramps in the back are the first signs that prevent a serious ailment from being identified in time.

The subsequent symptoms of spinal stroke, which appear gradually, push the patient towards a more thorough examination:

  • feeling of numbness in the legs - the body may suddenly disobey its owner, as the hard surface of the ground will not be felt by the legs;
  • loss of touch and tactile sensations - a person may not feel touching the body, inflicted pain or, for example, a rise in temperature;
  • disorder in the work of the pelvic organ - bowel disorder, fecal and urinary incontinence, bloating of the bladder, inflammation of the kidneys;
  • violations of the trophism of the body;
  • increasing pain in the spine with an intense character.

Diagnostics

It is not possible to diagnose spinal stroke visually during examination. Only an integrated approach, which includes a number of studies, as well as patient complaints, will help to identify and assess the state of the disease.

First of all, it is necessary to carry out magnetic resonance therapy, which allows you to determine not only the presence of the disease itself, but also its stage of the course.

In order to completely restore the picture of the patient's condition, they also prescribe:

  • somatic diagnostics of the cardiac and vascular systems, as well as other organs, if necessary;
  • electroneuromyography, which allows you to determine the real state of nerve endings and muscles;
  • rheoencephalography - a non-invasive method in which the vessels of the brain are assessed;
  • x-ray examination of the spine;
  • doppler ultrasound - with its help you can set the blood flow velocity.

The treatment of each individual case, depending on the affected area, will differ, so often doctors also resort to puncture.

Treatment

In the case of ischemic spinal cord injury, treatment will focus on restoring blood flow to the site of the injury. This will require taking medications that thin the blood so that it “seeps” through the barrier. In more severe cases, if there are clots, they may need to be removed promptly.

Surgical intervention cannot be avoided in case of hemorrhagic stroke of the spinal cord, since it is necessary to ensure the restoration of the integrity of the blood vessels. The task for neurosurgeons in this case is not easy.

In any of the cases, the patient will need inpatient treatment, where it is necessary to create all conditions in order to avoid the formation of bedsores or the development of pneumonia. For this, the patient is daily wiped with wet towels, changed, as prescribed by doctors, therapeutic massage procedures are carried out, and fixed in certain positions. Proper nutrition is also important to prevent intestinal upset.

Rehabilitation

The period of rehabilitation after a previous illness may have different periods. Sometimes the patient is assigned a temporary disability group, so he may be limited in his ability to work. In addition, the initial recovery period is best spent in a specialized sanatorium.

It is better to carry out all manipulations during rehabilitation under the supervision of physiotherapists and not to give up periodic dispensary examinations. To improve the indicators of physical activity, massages and exercise therapy are performed.

The load on the spine in a person after a spinal stroke in the future should be minimal, as much as possible. For sleep, it is better to choose a good orthopedic mattress, and during periods of intense physical activity, which entail stress, do not neglect a supporting corset.

Forecast and possible consequences

In general, the prognosis for patients with spinal stroke is good. The risks of death are minimal. However, timely and appropriate treatment is needed to get rid of the disease completely.

In case of neglect of the process, damage to blood vessels and nerve endings can take on a more extensive character, which will entail complete paralysis of the lower extremities and changes in the functional activity of other organs that cannot be restored.

Spinal stroke is a pathology characterized by circulatory disorders in the spinal cord. The disease is detected less often than hemorrhages in the brain, but sometimes it can affect its development. A spinal cord stroke causes disability. When threatening symptoms appear, the patient must be urgently taken to the hospital, since the effectiveness of therapy will depend on how quickly medical care is provided.

Distinguish between ischemic, hemorrhagic and combined strokes of the spinal cord. The causes of ischemic damage are as follows: squeezing, ruptures, clogging of blood vessels due to hernias, blood clots, sclerosis, neoplasms of a different nature. Hemorrhagic stroke (hemorrhage) of the spinal cord appears due to blood diseases, injuries of the spinal column, neoplasms. The combined lesion of the spinal cord is manifested in both forms.

Let us consider in more detail the causes of pathology. There are primary vascular lesions of the spinal cord, when an acute condition develops due to vascular pathology, and secondary lesions, when the vessels are damaged due to processes influencing from the outside. In the first case, the causes of spinal cord injury are:

  • somatic diseases (hypertension, heart failure, heart attack, atherosclerosis, etc.);
  • vasculitis (inflammatory lesions of the walls of blood vessels);
  • vascular malformations (incorrect connection of veins with arteries);
  • vascular pathologies (stenosis, thrombosis, varicose veins, etc.).

In the second case, a spinal cord stroke appears for the following reasons:

  • spine diseases;
  • lesions of the spinal cord membranes;
  • neoplasms in the spine, spinal cord.

The beginning of the development of the disease

A spinal cord stroke begins with back pain. Then the person feels pain and weakness in the legs. Spinal cord lesions are accompanied by disturbances in the normal functioning of the pelvic organs. These include: incontinence or retention of feces and urine, tenesmus (false desires). Circulatory disorders in the spine cause neuronal death and tissue destruction.

If there is a suspicion of a spinal cord stroke, the patient should lie on his back. After that, you should call an ambulance. Patients with spinal stroke are transported on a solid shield. The patient should be in a supine position (lying on his back). The diagnosis of "spinal stroke" is made in the hospital after examining the patient. To determine the nature of the lesions, magnetic resonance imaging (MRI) and electroneuromyography are performed. A blood test is also done.

Ischemic stroke of the spinal cord proceeds as follows. A few days or weeks before the development of the pathology, weakness appears in the legs and arms. Sensory disturbances in the limbs are observed. These include: burning sensation, numbness, the appearance of "goose bumps" on the skin and discomfort in the muscles. Disorders of urination (frequency, delay), urge to urinate appear. Another symptom of spinal ischemic stroke is back pain, and the pain radiates (radiates) to the arms or legs.

Spinal cord lesions develop within minutes or hours. This stage is accompanied by the following symptoms: weakness in the limbs, loss of sensitivity, dysfunction of the pelvic organs. Spinal stroke may be accompanied by signs of brain damage. These include: weakness, vomiting, nausea, headache, dizziness, fainting.

Spinal hemorrhagic stroke occurs when a spinal cord hemorrhage occurs. Its signs are: acute pain and paralysis of the limbs. Extensive hemorrhage is accompanied by dysfunction of the limbs, disorders of the normal function of the pelvic organs. Back pain is combined with symptoms of spinal cord compression. These include: weakness, numbness and tingling in the legs, pain in the spine, dysfunction of the pelvic organs.

A subspecies of hemorrhagic stroke of the spinal cord is hematorchis. It is characterized by hemorrhage in the subarachnoid space of the spinal cord (the cavity between the arachnoid and pia mater of the spinal cord and brain). The main symptoms of pathology include pain in the spine. Sometimes the pain can be shingles. When a hemorrhage occurs, nausea, dizziness, headache, and sometimes disturbances of consciousness appear.

Spinal ischemic stroke treatment

Spinal cord stroke therapy is prescribed depending on the causes and localization of the pathology. Distinguish between conservative and surgical treatment of the disease. The following medications are used as a conservative therapy for ischemic stroke of the spinal cord:

  • drugs that inhibit the activity of the blood coagulation system and prevent the appearance of blood clots (Plavix, Heparin, Kurantil);
  • vasoactive agents affecting the mechanisms of regulation of blood circulation ("Cavinton", "Enelbin", "Nicergoline");
  • venotonic drugs for strengthening the walls of blood vessels (Troxevasin, Eskuzan);
  • anti-inflammatory nonsteroidal drugs ("Nimesulide", "Diclofenac");
  • angioprotective drugs that reduce the permeability of the walls of blood vessels ("Troxerutin", "Askorutin", "Calcium Dobezilate", "Troxerutin");
  • neuroprotective agents that prevent neuronal damage (Tanakan, Riboxin, Cerebrolysin);
  • diuretics (Furosemide);
  • medicines that reduce muscle tone (Mydocalm);
  • preparations containing B vitamins (Milgamma).

For patients with spinal stroke, the following therapeutic measures are also prescribed: blockade with medication, immobilization of the affected spine, traction, exercise therapy, physiotherapy.

Hemorrhagic Spinal Stroke Treatment

Conservative therapy for hemorrhagic stroke of the spinal cord includes the appointment of the following drugs:

  • means that strengthen the walls of blood vessels ("Ditsinon", "Kontrikal");
  • neuroprotectors and angioprotectors;
  • drugs that prevent the development of vasospasms ("Verampil", "Nimotop").

Surgery for spinal stroke is prescribed if conservative therapy has been ineffective. Surgical intervention is also performed for mechanical damage to the spinal cord or detection of neoplasms.

When caring for patients with spinal stroke, great attention should be paid to preventing the development of the following complications: pressure sores, pneumonia, infectious diseases of the genitourinary system. They develop in the case of poor quality care for a patient who has suffered a spinal cord stroke.

To prevent bedsores from appearing, you need to turn the patient over every 1-1.5 hours. Wipe his body with camphor alcohol, use talcum powder to powder the skin and change clothes more often. In order to prevent the appearance of pressure ulcers, it is recommended to use devices (rubber circles, rings). If a person cannot urinate on their own, a catheter should be inserted. For incontinence, a urine bag is used.

Note!

To prevent the development of pneumonia, a patient with a spinal cord stroke, who is on bed rest, must perform breathing exercises (for 5 minutes at a frequency of 1 time per hour).

When the patient recovers, he needs to gradually increase physical activity.

The outcome of a spinal cord stroke is different. Complete recovery is possible under the following conditions: small size of the lesion, treatment started on time. The patient should be under dispensary observation. Preventive courses of therapy are also needed.

The less positive outcome of the transferred spinal cord injury implies that the patient retains various disorders that can lead to disability. These include: paresis of the extremities (weakening of motor function), anesthesia or hypesthesia (loss or decrease in sensitivity), dysfunction of the pelvic organs.

When areas of hypesthesia or anesthesia appear on the body or limbs, sensitivity is reduced or absent. There are the following types of sensitivity: tactile, temperature, pain, stereognosis, sense of localization, two-dimensional sense, etc. For some patients, hypesthesia or anesthesia can cause disability. For example, a musician will not be able to play if his hands become insensitive. With paresis of the extremities, weakness remains in the muscles, so the patient has difficulties with self-care.

One of the most unpleasant consequences of spinal cord lesions are dysfunctions of the pelvic organs: incontinence of feces, urine, uncontrolled defecation and urination, as well as periodic excretion of urine in small quantities.

Rehabilitation after treatment of a spinal cord stroke in a hospital can take quite a long time, sometimes for several years. This is a laborious process that requires active interaction between the patient and the doctor. High-quality rehabilitation allows many patients to return to normal life after suffering a spinal cord stroke. During the recovery period, it is necessary to conduct courses of taking medications - at least once every six months.

Physical therapy plays a special role. A set of exercises is developed by a rehabilitologist individually in each case. Many patients with spinal cord injury will require special devices (walkers, walking sticks) for movement, orthopedic shoes.

The reduction of the rehabilitation period after the treatment of spinal stroke is facilitated by courses of massage and acupuncture, which show good efficiency. To eliminate muscle weakness, patients with a spinal cord stroke are prescribed electrical stimulation. Rehabilitation also includes the following activities: magnetotherapy, phonophoresis, electrophoresis, applications, therapeutic baths. Since the disease leads to a dramatic change in lifestyle, patients need psychosocial adaptation.

Patients who have suffered a spinal stroke get a disability. With a favorable outcome of the disease, they can work, and they are selected to work in accordance with the state of the body. Sometimes rehabilitation measures do not give a positive result, then patients after a spinal cord stroke are not able to serve themselves on their own. In this case, they need special care.

Disease prevention

The goals of spinal stroke prevention are to identify and eliminate the causes and unfavorable factors due to which the disease develops. It is necessary to deal with the treatment of vascular diseases, osteochondrosis, atherosclerosis in time. It is necessary to visit a doctor annually for a preventive examination. You should eat right, exclude bad habits, avoid back injuries. It is recommended to exercise to strengthen the muscles.

Note!

To prevent the development of a spinal stroke, you need to monitor blood pressure and, if necessary, take medications that lower blood pressure.

Spinal stroke is a disease arising from acute circulatory disorders in the spinal cord. It is equally likely to develop in both sexes over the age of 30.

Spinal cord strokes are less common than cerebral strokes and are rarely fatal.

But at the same time, it requires no less attention, since often untimely identification of the problem and the lack of qualified treatment leads to the patient's disability. In addition, a circulatory disorder in the spinal cord can cause a similar disease in the brain.

Based on the nature of the onset of pathology, there are three types of strokes:

There are many factors that trigger a spinal stroke. Basically, they are associated with diseases of the spine. Doctors group them as follows:

  1. Primary vascular lesions: hypertension, atherosclerosis, heart failure, myocardial infarction, varicose veins, vasculitis, thrombosis, stenosis.
  2. Secondary vascular lesions: osteochondrosis, hernia, tumors, enlarged lymph nodes, inflammatory processes in the membranes of the brain.
  3. Other reasons: spinal injuries, consequences of unsuccessful operations, hemophilia, diabetes mellitus, hypothyroidism, thrombocytosis.

Symptoms, stages and treatment of pathology

A spinal stroke is difficult for a person without medical education to diagnose due to the variety of its clinical manifestations. But there are symptoms that make you wary and seek help from a medical facility. The consequences and duration of the patient's recovery will depend on this.

Before a spinal cord stroke develops, a person feels the harbingers of the disease:

  • pain in the legs, back;
  • lameness;
  • disorders in the work of the pelvic organs;
  • weakness;
  • numbness of the lower and / or upper limbs.

Most often, these symptoms are not cause for concern or are associated with other medical conditions. The duration of the period of precursors of acute pathology is individual. Sometimes it drags on for several months.

After, in the absence of correct treatment, a spinal cord stroke develops. Symptoms become pronounced and specific. The patient has:


Having found signs of pathology, it is important to deliver the patient to a specialized clinic as soon as possible. Before the ambulance arrives, the person should be laid on their back on a flat, hard surface.

Neuropathologists distinguish the following stages of the development of the disease:

  1. Harbingers.
  2. Stroke itself.
  3. Regression.
  4. Residual (residual) phenomena.

Patients diagnosed with spinal stroke are admitted to the neurological department.

They are provided with bed rest, control of bowel movements, and measures are taken to prevent pressure ulcers and pneumonia. If necessary, artificial lung ventilation is performed.

The first medication is administered to a patient in an ambulance. Doctors use diuretics to remove excess fluid from the body and reduce the likelihood of developing cerebral edema (Furosemide, Lasix).

After an individual diagnosis and an accurate diagnosis, further treatment is prescribed.

In the drug therapy of ischemic and hemorrhagic strokes, drugs are used that:

  • normalize blood circulation and metabolism in the spinal cord (Actovegin, Metamax);
  • strengthen the walls of blood vessels and improve microcirculation (Askorutin, Troxerutin, Troxevasin);
  • restore the activity of neurons (Cerebrolysin, Nootropin, Vinpocetine);
  • relieve muscle spasm (Midocalm);
  • improve the mechanism of nerve impulse conduction (Neuromedin).

Medicines that thin the blood and prevent the formation of blood clots (Curantil, Aspirin, Heparin, Plavix) are used only for the treatment of ischemic type of pathology.



The neuropathologist determines the dose of drugs and the duration of the course of treatment, focusing on the test results, symptoms of the disease and the dynamics of recovery.

If the stroke is caused by a vertebral hernia, tumor or other damage to the spinal column and this pathology is the main one, surgery is used. Surgery is often prescribed for hemorrhagic stroke to remove the hematoma.

Recovery forecast and recovery rules

Spinal stroke is a pathology that is characterized by a relatively favorable prognosis for recovery; death is rare.

Despite this, the disease can have serious consequences in the absence of timely treatment.

A common disorder after a stroke is paresis or paralysis of the limbs. Most often, there is a lesion of two lower extremities, less often - paresis or paralysis of one leg or arms. Sensitivity in the musculoskeletal system is impaired (sensitive ataxia).

Often, the consequences of a stroke affect the work of the pelvic organs and lead to:

  • urinary incontinence;
  • impotence;
  • problems with bowel movements.

People who have had a spinal stroke get a disability. The ability to work most often remains, but you need to choose a job taking into account the characteristics of the patient's condition.

The rehabilitation process is lengthy and requires a lot of effort. Its active phase occurs in the first six months, but sometimes it may take longer to recover. Particular attention should be paid to the mental state of the patient. Consequences such as paresis of the muscles of the extremities or their paralysis, fecal and urinary incontinence, provoke depression and a deterioration in the general condition of the patient. The warmth and care of loved ones can help maintain peace of mind and improve your recovery prognosis.

The main methods used for rehabilitation are as follows:


Physiotherapy should be carried out strictly under the supervision of a doctor. Spa treatment provides maximum results.

It is not always possible for a person to completely restore the lost functions. In some cases, complete immobility is observed, then the patient cannot serve himself and he needs special care.

With paralysis of the lower extremities, a person will be able to move around using a walker or walking stick, orthopedic shoes are also appropriate.

Even if he managed to return to his usual way of life, the patient should not forget that the spine is now his weak point. Therefore, it is advisable to use orthopedic mattresses and pillows, corsets in everyday life. They will help reduce stress on the spinal column.

In addition, a person should not forget about measures that will help to avoid relapses and deterioration of health. These include:


Men and women get sick with the same frequency between the ages of 30 to 70 years and older.

During the course of the disease, several stages can be distinguished:

1) the stage of precursors (far and near);

2) the stage of stroke development; 3) the stage of reverse development;

4) the stage of residual phenomena (if complete recovery has not come).

Precursors of ischemic spinal stroke are paroxysms of transient spinal disorders (myelogenous, caudogenic or combined intermittent claudication, transient pain and paresthesia in the spine or in the projection of the branching of certain spinal roots, disorders of the function of the pelvic organs).

The rate of onset of a stroke is different - from sudden (with embolism or traumatic compression of the vessels supplying the spinal cord) to several hours or even days.

It has already been mentioned that spinal infarction is often preceded by pain in the spine or along the individual roots.

The cessation or significant subsidence of this pain after the development of myeloischemia is characteristic. This occurs due to a break in the passage of pain impulses along the sensitive conductors at the level of the spinal cord ischemia focus.

Clinic... The clinic of ischemic spinal stroke is very polymorphic and depends on the prevalence of ischemia both along the length and across the spinal cord. Depending on the extent of ischemia across the spinal cord, the following variants of the clinical picture are encountered.

Syndrome of ischemia of the ventral half of the spinal cord (syndrome of blockage of the anterior spinal artery). It is characterized by the acute development of paralysis of the limbs, dissociated paranesthesia, and dysfunction of the pelvic organs. If ischemia is localized in the cervical segments of the spinal cord, paralysis (paresis) develops in the arms flaccid, in the legs - spastic. Ischemia of the thoracic segments is manifested by lower spastic paraparesis, myeloischemia of the lumbosacral localization - by lower flaccid paraparesis. The upper limit of dissociated paranesthesia helps to navigate the extent of the ischemic focus along the longitudinal axis of the spinal cord. The joint-muscular and tactile sense is not disturbed. Ischemia of lumbosacral thickening is manifested by inferior flaccid paraplegia with reflexia, dissociated paranesthesia, urinary and fecal retention. This symptom complex is called the Stanilovsky-Thanon syndrome.

Anterior ischemic poliomyelopathy syndrome... This syndrome is one of the variants of partial damage to the structures of the ventral half of the spinal cord. It is characterized by the rapid development of flaccid paresis of certain muscle groups of the upper or lower extremities with areflexia and muscle atrophy and EMG changes, indicating ischemia within the anterior horns of the spinal cord. This syndrome has to be differentiated from poliomyelitis, in which signs of an infectious lesion of the body and the stage of gastrointestinal disorders are revealed.

Ischemic Brown-Séquard Syndrome... Occasionally encountered. It differs from a typical compression lesion of half of the spinal cord in that during ischemia, the posterior cords remain preserved, therefore, the joint-muscular feeling on the side of the central paralysis of the limb is not disturbed. The anatomical justification of this variant of myeloischemia has already been mentioned, it is associated with the fact that individual sulcus-commissural arteries supply only one, right or left, half of the spinal cord diameter.

Centromedullary ischemia syndrome... It is characterized by acute or subacute development of segmental dissociated anesthesia with the loss of the corresponding segmental deep reflexes and slight peripheral paresis of the same myotomes. According to the clinical picture, it resembles syringomyelia (ischemic syringomyelic syndrome).

Ischemia syndrome of the marginal zone of the anterior and lateral cords... It is manifested by spastic paresis of the extremities, cerebellar ataxia and mild conduction parahypesthesia. The acute onset of the disease and the subsequent possibility of an intermittent course resemble the spinal form of multiple sclerosis. Monitoring the further development of the disease helps diagnostics.

Ischemic syndrome of amyotrophic lateral sclerosis... It develops more often in the upper arterial basin of the spinal cord. The clinical picture is characterized by weakness of the distal upper extremities, atrophy of small muscles of the hands, increased deep reflexes, pathological hand and foot marks. Fascicular twitching of the muscles of the shoulder girdle is possible. With this syndrome, there is no spread of paretic phenomena to the bulbar muscle group (tongue, larynx and pharynx).

Dorsal spinal cord ischemia syndrome (Williamson syndrome)... It is rare and is associated with posterior spinal artery occlusion. In such patients, acutely sensitive ataxia appears in one, two or more limbs, moderate spastic paresis of the same limbs, segmental hypoesthesia, indicating the level of ischemia localization, vibration sensitivity in the legs is lost.

Spinal cord ischemia syndrome... It develops when the large radicular-spinal artery is turned off, which is involved in the formation of both the anterior and posterior spinal arteries. Almost always, such a topography of the focus is observed when the venous outflow from the spinal cord is impaired (thrombosis or compression of the spinal and radicular veins). The details of the clinical picture vary depending on the level of the lesion (cervical, thoracic or lumbar segments).

Knowledge of the typical variations in the distribution of the radicular-spinal arteries in some cases makes it possible to clinically determine the affected pool of such an artery. Let us give a brief clinical picture of myeloishemia when individual spinal arteries are turned off.

Large anterior cervical radicular-spinal artery occlusion syndrome (cervical thickening artery)... It manifests itself as flaccid or mixed paresis of the upper limbs and spastic lower, segmental and conduction disorders of sensitivity, dysfunction of the pelvic organs in the central type.

When the upper accessory radicular-spinal artery is turned off, the lower paraparesis, dissociated paranesthesia with the upper border on the Th-Lh2 segments, develops sharply. Urinary retention sets in. Initially, knee and Achilles reflexes usually fade away. However, Babinsky's symptom is always called. In the next 5-6 days, the lower paraparesis acquires the features of the central one (muscle tone increases, deep reflexes revive). Sensory disorders are usually concentrated in the area of \u200b\u200bthe upper thoracic dermatomes. In the residual stage, along with signs of damage to the Th, -Th5 segments, the extinction of deep reflexes in the hands, hypotrophy of the small muscles of the hands are sometimes observed. Mild signs of damage to the peripheral motor neuron are confirmed by electromyography. These symptoms can be considered distant.

Adamkevich's artery off syndrome... The clinical picture in this case is quite varied. It depends on the stage of the disease. In the acute phase of stroke, flaccid lower paraparesis (paraplegia), dissociated or rarely total paranesthesia with the upper border oscillating from the Th4-Z segment are always found. The function of the pelvic organs always suffers (incontinence or retention of urine, feces). Pressure ulcers often quickly join. In the future, with a decrease in ischemic events, many symptoms undergo a reverse development. Sometimes individual segmental reflexes are restored or pathological foot marks appear. The level of sensitivity disorders decreases. Its violation is uneven (against the background of anesthesia - areas of enlightenment).

If initially the anesthesia is total, then in the future, the joint-muscular feeling is almost always restored. This is due to the rapid compensation of blood flow in the pool of the posterior spinal arteries. In this stage of reverse development, as well as in the period of residual phenomena, the clinical picture individually varies depending on the location and size of the foci of irreversible ischemia of the spinal cord segments. Clinical and anatomical observations show that the degree of ischemic changes is not the same in the basin of the switched off artery. Usually, along with areas of complete necrosis of brain tissue, there are zones of lighter ischemia.

Ischemic changes are often found not only in the basin of the occluded artery, but also in the adjacent parts of the spinal cord, manifesting themselves in the so-called distant (distant) symptoms. For example, when Adamkevich's artery is blocked, signs of cervical thickening (peripheral paresis of the hand, paresthesia) sometimes develop.

Turning off the great anterior radicular-spinal artery of Adamkevich often leads to ischemia of a significant number of spinal cord segments

Syndrome of occlusion of the inferior accessory root-spinal artery. It develops more often due to compression of the herniated disc L, v-Lv or Lv-S, and is usually manifested by a syndrome called paralyzing sciatica or radiculoischemia with paresis of the muscles innervated by the L4-S segments. To the forefront of the clinical picture are paralysis of the peroneal, tibial and gluteal muscles, sometimes segmental sensory disorders.

Often, ischemia develops simultaneously in the segments of the epicone and cerebral cone. In such cases, disorders of the function of the pelvic organs join the paralysis of the corresponding muscles.

It should be noted that angiotopic diagnosis is always fraught with difficulties. The reason for this is the large individual variability in the distribution of the radicular arteries. As a result, even an accurate topical diagnosis of the lesion does not provide sufficient criteria for determining which of the arteries has lost patency. Recognition is hampered, in addition, by the dynamism of clinical manifestations. This requires the study of individual variants of the clinical picture, based on the prevalence of ischemia both along the length and across the spinal cord.

Diagnosis. When recognizing spinal cord ischemia, precursors in the form of myelogenous intermittent claudication or transient paresis, dyscalgia, radiculalgia, etc. are taken into account. The rate of development of the disease (acute or subacute), the absence of signs of inflammation or acute compression of the spinal cord are important. According to the clinical picture, one can, at least presumably, think about the defeat of one or another vascular basin. More often this refers to the anterior spinal artery and the anterior radicular-spinal trunks of different levels of the spinal cord that form it.

According to the peculiarities of the clinical picture, it is possible to carry out differential diagnosis between arterial and venous radiculomyeloischemias.

Arterial radiculomyeloischemia develops acutely or subacutely, usually after a period of precursors and against the background of a hyperalgic crisis, followed by cessation or a significant decrease in pain. Symptoms are characteristic of lesions predominantly of the ventral half of the spinal cord diameter.

Additional research methods are of great help in diagnostics. Occlusion of the aorta and its branches in some cases can be confirmed by angiography. It should be noted that areas of atherosclerotic calcification of the aortic wall and its aneurysm are often found on lateral spondylograms. Certain information about the condition of the spinal cord can be obtained with CT and MRI.

Compression factors in patients are specified using spondylography and myelography. It is necessary to speak about complicity of ischemia in cases of detection of a discrepancy between the level of lesion of the spine and the border of the medullary focus, determined by clinical data. CSF research is valuable. The absence of a block of the subarachnoid space and a normal composition of the CSF occur in one third of patients. However, often in the acute phase of spinal stroke, there are significant changes in the fluid (an increase in the protein content from 0.6 to 2-3 g / l and even higher, sometimes this is combined with moderate pleocytosis - from 130 to 150 cells in 1 μl). Particularly altered CSF occurs with impaired outflow. In the acute stage of a stroke, it is possible to detect a block of the subarachnoid space, which is caused by edema and thickening of the spinal cord itself. With repeated lumbar punctures after 1–2 units, the CSF usually normalizes and there is no subarachnoid block.

Electrophysiological methods of research make it possible to identify a violation of the innervation of even those muscles in which signs of damage cannot be found in a conventional clinical study (sufficient muscle strength, no change in their tone).

Treatment... They are carried out in several directions. The first of them is aimed at improving local blood circulation by including collaterals and increasing the volumetric blood flow velocity. For this purpose, prescribe vasodilators, venotonic agents that improve cardiovascular activity, decongestants, antiplatelet agents, antihypoxants.

The second direction of therapeutic measures includes the elimination of the occlusive process. With the thromboembolic nature of spinal stroke, anticoagulants (heparin, phenylin) and antiplatelet agents (acetylsalicylic acid, tiklid, curantil) are prescribed. In cases of compression-vascular spinal disorders, therapeutic tactics are aimed at eliminating the compression. Most often we are talking about a discogenic disease. These patients are used as orthopedic (tight bed, wearing a corset, massage of muscles along the spine, exercise therapy) and physiotherapy. In the absence of success from medication and orthopedic treatment, indications for surgical intervention are established. It is also performed for patients with intra- and extravertebral tumors. The choice of the method and the scope of the operation are decided on an individual basis in cooperation with neurosurgeons. Special tactics of therapeutic measures are followed for lesions of the aorta (coarctation, atherosclerotic aneurysm). The tactics should be determined in conjunction with the surgeons.

All patients, including in the postoperative period, are prescribed nootropic drugs, vitamins and biostimulants, with spasticity - muscle relaxants.

Regardless of the method of pathogenetic treatment used, in all cases of spinal infarction, especially careful patient care is required in order to prevent pressure ulcers and urosepsis.

The outcome of myeloischemia differs depending on the causative cause and treatment. In more than half of the patients, it is possible to obtain a favorable therapeutic effect: practical recovery and improvement with moderate residual effects. Fatal outcome is observed in spinal stroke due to a malignant tumor, dissecting aortic hematomas and in the development of concomitant diseases and complications in the form of myocardial infarction, urosepsis.

As for the labor prognosis, it depends on the severity and prevalence of neurological disorders in the residual stage.

The following expert criteria are adopted in addressing issues of work ability. The first group of disability is determined by patients with tetraparaplegia or deep paresis in combination with dysfunction of the pelvic organs, trophic disorders. These patients need outside care.

The second group of disability is established for patients with moderate paresis of the extremities and dysfunction of the pelvic organs. Such patients can do work at home. The third group of disabilities is prescribed for patients with mild paresis of the extremities without disorders of the function of the pelvic organs. These patients need rational employment.

Spinal type of stroke pathology

First of all, it should be said that the diagnosis of spinal stroke among physicians sounds only when in practice there is an acute, in form, violation of the so-called spinal circulation. In such pathological conditions, different types of damage to certain parts of the spinal cord necessarily occur.

Loss of function in the area controlled by the affected area of \u200b\u200bthe spinal cord

As a result, doctors are faced with a disorder of the basic functions of the body, which were controlled by the affected area of \u200b\u200bthe spinal cord, which can occur due to severe difficulty or a complete cessation of the flow of oxygen-enriched blood to the spinal cells. It should be said that spinal cord stroke has a rather modest frequency, according to the latest statistics, accounting for no more than 1% of all existing forms of stroke.

Referring to the course of human anatomy, we recall that the anterior spinal artery is adjacent to the front surface of our (human) spinal cord, and two (necessarily paired) posterior spinal arteries are adjacent to its posterior surface, which are responsible for the blood supply to the spinal cord. Some disturbances in the physiologically normal spinal circulation (blockages, spasms or rupture of these arteries) usually lead to a condition diagnosed as a spinal stroke. Similar problems can be caused by diseases such as:

  • Atherosclerosis.
  • Embolism.
  • Arterial hypertension and other etiological factors, which, by the way, may be common with the state of the ischemic cranial type of stroke pathology.

It must be understood that oxygen-enriched blood normally flows to the spinal arteries described above (anterior and paired posterior) from several large vascular basins. For example, clamping or some damage to such arteries as Adamkevich's artery, Deprozh-Gotteron's artery, or Lazort's artery, after injuries or unsuccessful surgical interventions, can also be the main reason for spinal stroke.

How does this disease proceed?

Statistics say that representatives of the strong and weak half of humanity hear the diagnosis of spinal stroke with exactly the same frequency. Moreover, most often (unless, of course, the state of spinal stroke pathology is caused by trauma or surgery) is between the ages of twenty-five and sixty-seventy years, and sometimes even older.

During the course of this disease, doctors distinguish several separate stages that will be described in the table below.

Spinal circulation disorders

Spinal cord circulatory disorders are quite rare compared to cerebral strokes, however, with age, the likelihood of having a spinal stroke increases due to the presence of concomitant diseases. Clinical studies show that men and women aged 30 and older get sick equally often.

Causes of impaired spinal circulation

The most common causes of the development of spinal circulation disorders are:

· Various vascular lesions responsible for the blood supply to the spinal cord (aneurysm, inflammatory vascular disease, varicose veins, atherosclerosis, coarctation of the aorta, heart disease);

· Diseases leading to external vascular compression (all sorts of tumors, herniated disc, swollen lymph nodes, spinal injury, rheumatism, osteochondrosis, ankylosing spondylitis);

· Injury of arteries during surgical interventions on nearby organs and during spinal anesthesia.

The cause of the disease may not necessarily be only one; often, there is a combination of several factors, for example, the presence of atherosclerosis and spinal injury. Also, a special role in the development of the disease is played by the state of collateral circulation, which depends on the degree of vascularization of the spinal cord and the presence of concomitant heart diseases, the state of hemodynamics.

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Classification of spinal circulatory disorders

Spinal circulatory disorders often lead to persistent neurological deficits with subsequent disability. Even minor damage can lead to paresis and plegias below the lesion. In some cases, they can also have a reversible effect. In accordance with the symptoms, cause and reversibility of the process, there is a classification of disorders of the spinal circulation.

· Transient spinal circulation disorders (all symptoms disappear after 24 hours);

· Acute disorders of spinal circulation: ischemic spinal stroke; hemorrhage under the lining of the spinal cord; hemorrhagic spinal stroke (in this case, the brain substance is affected);

· Chronic circulatory disorders.

According to experts, without appropriate treatment, the symptoms of circulatory disorders will continue to develop further, while their intensity will depend on where and which part of the spinal cord is damaged.

The most common ischemic strokes. With the transient nature of the violation of blood supply, pain, a feeling of numbness, weakness in the limbs, a violation in the work of the pelvic organs appear below the site of injury. Complaints appear and disappear for some time, but over time they can reappear and be harbingers of persistent circulatory disorders. In ischemic stroke, symptoms develop rapidly, and their manifestations will resemble those of a transient disorder.

With a hemorrhage into the substance of the spinal cord, flaccid paresis and paralysis begin to develop, a change in sensitivity occurs at the level of the lesion. The timing of the onset of signs depends on the degree of hemorrhage. Added to these symptoms are acute girdle pain in the spine, vomiting, headache. With hemorrhage in the lining of the spinal cord, local pain appears in the spine with a gradual increase in the symptoms of spinal cord compression (paresis and paralysis appear).

The rate of development of a stroke is also different, it can occur instantly or can develop within several hours or even days, it all depends on the cause of the disease and the degree of circulatory disorders. If a stroke develops instantly, then the patient may fall, he has symptoms of impaired sensitivity and motor activity, involuntary urination.

Diagnostics and treatment of spinal circulation disorders

When diagnosing a disease, the rate of development of symptoms, the presence and absence of concomitant diseases, and possible causes of circulatory disorders are taken into account. According to the symptoms, you can determine the level of damage, and which vascular pool is involved. In case of spinal circulation disorders, the patient needs to be examined by a neuropathologist, who, on the basis of complaints, a survey about the onset and symptoms of the disease, neurological symptoms and data from an objective examination, will make a diagnosis.

If necessary, the patient will be assigned additional studies and this:

· Examination of the cardiovascular system using ECG, ultrasound;

· Angiography - confirmation or refutation of narrowing of the aorta and its large branches;

· Magnetic resonance imaging, computed tomography.

· Radiography - identification of signs of arthrosis and osteochondrosis;

· Puncture of the spinal cord for the study of cerebrospinal fluid (cerebrospinal fluid). As a result of a stroke, cerebrospinal fluid pressure may increase, and a high protein content is observed.

In the treatment of spinal circulation disorders, etiotropic treatment and pathogenetic therapy are used:

- Etiotropic treatment is aimed at eliminating the causes of the disease. This includes surgery for tumors. aneurysm, angioma embolization.

- Pathogenetic therapy is carried out for the treatment of arterial hypertension, heart diseases, decongestant therapy is used, antiplatelet agents are prescribed, drugs to improve blood microcirculation and improve the nutrition of spinal cord tissues, antioxidants.

Preventive measures to prevent spinal circulatory disorders are mainly aimed at treating the main diseases leading to this pathology, maintaining a healthy lifestyle, giving up bad habits, and proper nutrition. Self-medication of the patient is completely undesirable, it is much safer for health and for human life to see a doctor in a timely manner!