Symptoms and treatment of acute circulatory disorders in the spinal cord. Spinal stroke treatment

Spinal stroke is an acute process caused by poor circulation in the spinal cord. Acute pain occurs in the back, accompanied by muscle tension. After a certain period of time, the legs begin to go numb, their sensitivity is disturbed, and weakness appears. Symptoms appear slowly over several days.

Causes

The main cause of spinal stroke is sclerotic changes in the vessels and aorta, which cause malnutrition of the spinal cord. The cause of the disease can be:

• tumors and intervertebral hernia, they squeeze blood vessels, causing circulatory disorders;
• surgical intervention, including spinal anesthesia;
• damage to the arteries and structures of the spinal cord;
• ischemic stroke in other parts of the brain;
• the presence of fragments of the spine due to its fracture;
• enlarged lymph nodes located in the chest and abdomen;
• diagnostic procedures on the spine;
• manual therapy;
• hemophilia and thrombocytopenia, varicose veins of the spine;
• myocardial infarction and other diseases of the heart and blood vessels, accompanied by impaired blood circulation;
• inflammatory processes that have led to a violation of the blood supply to the back.

The disease manifests itself in different ways. Symptoms depend on the location and the affected area. As a rule, the harbingers of spinal stroke are often confused with other diseases: kidney inflammation, exacerbation of sciatica and other diseases. Signs appear gradually and imperceptibly over a long time.

Initially, a sharp pain in the back may appear, which is often attributed to an exacerbation of sciatica. The symptoms of the disease are:

• legs: the patient ceases to feel a hard surface, sometimes the legs and body do not obey;
• loss of sensitivity: the patient does not feel the effects of temperature and pain;
• disorder of the pelvic organs: intestines, bladder, kidneys, which can be manifested by incontinence of feces and urine with complete or partial loss of control over the process;
• trophic disorders;
• intense and sharp pain in the spine.

Diagnostics

It is impossible to diagnose a spinal cord stroke by touch. The diagnosis is made in a comprehensive manner, taking into account the patient's complaints, external manifestations, for example, intermittent claudication, as well as special studies. The doctor prescribes magnetic resonance imaging. This examination allows you to track the lesion at any stage of development in all angles. To find out the complete picture, they also carry out:

• somatic studies of the state of the cardiovascular system and nearby organs;
• X-ray of the spine;
• rheoencephalography;
• ultrasound dopplerography.

Treatment

The acute course of a spinal cord stroke requires adherence to bed rest. The patient is placed on a flat surface face up and hospitalized in the neurological department of the hospital. Treatment depends on the cause of the disease. Initially, drugs are prescribed that will restore cardiac activity and pressure, metabolic processes. If necessary, blood thinning drugs are administered, drugs that relieve swelling or accelerate the regeneration of nerve tissues. Later, physiotherapy procedures are prescribed.

A spinal stroke quickly triggers the development of pressure ulcers and pneumonia. This is due to impaired circulation. Therefore, the patient is provided with careful care, therapeutic massages are performed, while simultaneously eliminating concomitant pathology.

Artificial ventilation is sometimes required.

The bed is often changed, the patient's body is fixed in various positions to prevent the appearance of pressure sores, and hygiene is strictly monitored. If the disease has arisen as a result of spinal injuries or in the presence of tumors and hernias, surgical treatment is performed.

If there is a disorder of the pelvic organs, systematic bowel movements are monitored. The patient's diet should be light, balanced and nutritious. In the presence of osteochondrosis, which has become the source of the disease, support corsets are prescribed. The duration of treatment depends on the causes of the onset, the area of ​​the lesion and the severity of the condition.

Rehabilitation and recovery

Rehabilitation after the treatment of spinal stroke is carried out at home under the supervision of a specialist and periodic dispensary examinations. It is aimed at restoring the mobility of the affected areas and eliminating all the negative phenomena that are present. In many cases, a disability group is established for the period of rehabilitation.

To restore the mobility of the affected areas, physiotherapy exercises, massages and other physical methods of treatment are prescribed. Such patients are recommended to be treated in specialized sanatoriums. During rehabilitation and in the future, a person who has had this disease should use an orthopedic mattress for rest, with prolonged exertion, always wear a support corset. Such products reduce the load on the spine, preventing the disease from recurring.

Forecast and consequences

In most cases, the prognosis for spinal stroke is good. This disease is not fatal. Timely treatment of concomitant diseases leads to a cure.

An unfavorable prognosis is possible only with extensive lesions of the spinal cord and nerve tissues, as well as severe disorders of the functioning of organs and the state of the body as a whole.

Such violations are rarely detected.

The consequence of a spinal stroke can be a partial loss of sensitivity of the extremities, disruption of the intestines and the urogenital tract, which are not always fully restored. Prevention of re-manifestation is aimed at eliminating the causes of the disease. It is unacceptable to engage in dangerous sports, it is not recommended to do strength exercises. The work is selected taking into account the recommendations of the doctor and the general condition of the patient.

Spinal stroke is a severe disruption of the blood supply to the spinal cord. In this case, the patient feels acute pain due to muscle tension. Further, other symptoms appear that give reason to suspect a violation of spinal conduction.

Consider the reasons for the appearance of such a disease, its symptoms and diagnostic methods, as well as the main consequences for the body.

General concepts

The spinal cord is supplied with blood from the aortic zone and the vertebral-subclavian artery. Moreover, the aortic areas feed the coccygeal, sacral and lumbar spine, as well as most of the thoracic segments.

In turn, the vertebral-subclavian artery supplies blood to the cervical spine and the first three thoracic vertebrae. Radicular-spinal arteries branch off from these large arteries.

The largest artery feeding the spinal cord is called the Adamkevich artery. If its activity is disturbed, then the patient develops symptoms characteristic of a spinal stroke. Sometimes it is possible to turn off the anterior spinal artery, on which the vascularization of most of the diameter of the brain depends.

Patients generally develop cerebral ischemia, and only in the rarest cases hemorrhage can occur - an outpouring into the area of ​​the nervous system under consideration.

Why does this disease develop?

A spinal cord stroke occurs due to acute sclerotic changes in the vessels and aorta. Because of this, the blood supply to the spinal cord is severely disrupted. The reasons for the development of the disease are:

• spinal cord tumors;
• intervertebral hernia;
• surgical operations;
• spinal pain relief;
• destruction of the arteries of the specified part of the NS;
• ischemic stroke;
• fracture of the spine and damage to the spinal cord with bone fragments;
• enlarged lymph nodes, if they are located in the chest and abdominal cavity;
• different methods of diagnostics on the spine;
• manual methods of influence (if they were carried out illiterately, without observing the basic rules);
• blood disorders (for example, thrombocytopenia or hemophilia);
• varicose veins of the vertebral vessels;
• any pathologies of the heart and blood vessels, if they are accompanied by disorders of the blood circulation process;
• inflammation, if they lead to various disorders of the blood supply to the back.

A person can have several causes of spinal stroke at the same time. This means that the risk of getting sick is significantly increased. Regardless of the cause of the development of the disease, the brain tissue suffers. Its work is disrupted as a result of exposure to poured blood, as well as due to a violation of the blood supply, therefore characteristic symptoms develop.

What you need to know about the signs of illness

Spinal stroke symptoms can be very varied. They depend on the location of the diseased area of ​​the brain. Cerebrospinal stroke is insidious in that its manifestations can be confused with other diseases, for example, with kidney pathology, sciatica, etc.

The first signs of the disease are usually ignored by the patient, he simply does not pay any attention to them. Meanwhile, the disease develops, its signs are becoming more and more noticeable.

The stage of the first signs, or precursors, can last for several weeks. In this case, patients have severe weakness in the legs or arms, discomfort in the fingers, joints and muscles. Disorders of urination are sometimes observed.

Such precursors are enhanced by alcohol consumption, hypothermia, overexertion, sudden movements, etc.

In the acute stage, such signs appear (they develop very quickly, in a few minutes):

1. Limb paresis and loss of sensation.
2. Disorders of the pelvic organs.
3. Termination of pain syndrome.
4. Spontaneous headache and dizziness.
5. Nausea.
6. Great weakness.

At the stage of reverse development, manifestations stop growing. In the future, the patient may be disturbed by the residual effects of a cerebrospinal stroke.

It is necessary to pay attention to such manifestations of spinal stroke as:

1. Numbness of the lower extremities. This means that a person gradually ceases to feel the surface under his feet. He feels that he cannot walk confidently on the ground or on the floor.
2. The ability to feel temperature and pain is gradually lost.
3. There is a disorder in the work of internal organs - the bladder and intestines. Often, the disease manifests itself in the fact that the patient develops urinary and fecal incontinence. At an advanced stage, he completely loses the ability to control such processes.
4. Various tissue nutritional disorders appear.
5. Finally, the person feels pain in the spinal region. They can be very intense and pungent.

Features of the hemorrhagic type of disease

If there is a hemorrhage in the spinal cord, then the patient develops pain of a girdle nature in the trunk or lower back. At the same time, unilateral or bilateral paralysis develops. Most often they are lethargic. Pain and heat sensitivity is impaired.

Severe hemorrhage leads to the development of tetraparesis. With a large hematoma, there will always be residual symptoms (residual). But small hematomas, as a rule, resolve.

Hematorchis is an outpouring of blood into the subarachnoid space. It is very rare. In this case, a sharp pain appears, spreading along the spinal column. It can be very harsh and girdle. Such pain lasts for a long time.

Disease treatment principles

Note that the duration of treatment for such a pathology depends on what stage it is at. Acute hemorrhagic stroke of the organ in question requires immediate hospitalization.

The patient should be on bed rest. Moreover, during hospitalization, the patient is placed on a hard surface and always in the "face up" position. Hospitalization is usually carried out in the neurology department of the hospital.

Initially, such a patient is prescribed drugs that can restore the normal functioning of the heart. If there is a danger of thrombus formation, he needs to inject drugs that can thin the blood, relieve developing edema and other symptoms. It is imperative to provide conditions for the normal restoration of nerve tissue.

It must be borne in mind that such a disease provokes the formation of pressure ulcers and pneumonia.... Such negative consequences of a cerebrospinal stroke are associated with acute circulatory disorders. So for the patient, proper care and exercise therapy are extremely important.

To prevent bedsores, it is necessary to change the patient's bed and his posture. It is especially important to strictly monitor the patient's hygiene.

If a hernia occurs, urgent surgical treatment is indicated. It is extremely important to monitor the normal bowel movement. If the patient develops osteochondrosis, wearing a corset is indicated.

A complex of such drugs is used:

1. Anticoagulants - to thin the blood and prevent blood clots.
2. Vasoactive drugs such as Cavinton.
3. Preparations for increasing the tone.
4. Angioprotective agents, for example, such as Ascorutin, Calcium dobesilate, etc.
5. NSAIDs (for example, such as Ibuprofen, Diclofenac and others).
6. Decongestants.
7. Drugs for lowering neuromuscular conduction (in particular, such as Neuromidin).
8. Vitamins from group B.

Additionally, drugs are used that can strengthen the vascular wall, drugs for the prevention of vasospasms and other drugs that protect the nerve sheaths. If these measures do not help, then an operation is prescribed.

Are folk remedies effective? They can be used as complementary therapeutic measures. They are not used as a monotherapeutic agent.

Features of the recovery of patients

Usually, the rehabilitation of such patients is carried out at home. However, if the patient is at home, he must be monitored by a doctor. From time to time it is necessary to undergo medical examination. For the period of recovery, patients are assigned an appropriate disability group.

The rehabilitation process is closely related to the restoration of the mobility of body parts. Physical therapy during the recovery period is extremely necessary for every patient.

It will be better if the patient undergoes some of the components of the treatment in the conditions of specialized clinics, since all the necessary conditions for a speedy recovery have been created there.

In the future, patients who have suffered a spinal stroke and the period of rehabilitation after it are recommended to sleep on orthopedic mattresses. If the patient's activity is related to physical activity, then he needs to wear special corsets. All this helps to reduce the stress on the spine.

If the patient cannot urinate on his own, then he is given catheterization. If the person is incontinent, a urine bag is used. To prevent the development of pneumonia, breathing exercises must be performed.

What you need to know about later life

Usually, the prognosis of cerebrospinal stroke is good. This disease is not fatal. Prompt treatment of concomitant pathologies contributes to the positive outcome of such a stroke.

However, it must be borne in mind that an unfavorable prognosis of the disease is possible if large areas of the spinal cord are affected. The same is true if the affected area has affected areas of the brain that are responsible for the normal functioning of important organs. Or if the normal functioning of the whole organism is disrupted. Fortunately, such cases are rare.

One of the most common consequences of a spinal cord stroke is loss of sensation in the limbs and bowel disruption. As a rule, they recover, but this is not always the case. After a spinal stroke, you need to forget about dangerous sports, and you should also not engage in strength exercises.

It must be remembered that this is a rather dangerous pathology. And the further restoration of the functions of the human spinal cord depends on when the treatment is started, to what extent the rehabilitation measures are carried out. The trend towards a favorable outcome does not mean that the disease can be completely cured.

Acute violation of cerebrospinal circulation is called, occurring 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 approximately 47: 1 (on average 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.

The 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 coming up to it together with the spinal roots, forming the aortic pool. The largest of the anterior radiculo-medullary arteries is called the "large anterior radiculo-medullary artery" or "Adamkevich's artery" (lumbar thickening artery).

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 radiculo-medullary 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 assessed as a set of basins of the anterior and posterior radiculo-medullary arteries located one above the other.

The clinical difficulty of identifying an artery affected by spinal bleeding lies in 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 elderly people (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 an 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. Subsequently, 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 retention.

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, developing 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 area 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 step-by-step therapy. Its nuances are determined depending on the variant of the clinical course.

Urgent measures should 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 circulation, bypass grafting of the aorta and intercostal arteries, if they are involved 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, electrical stimulation of the spinal cord, magnetic stimulation, magnetotherapy.

The systematic use of anti-sclerotic drugs, nootropics, 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 intervertebral 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 admitted to a neurological unit or 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 the dosage of the drug 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. 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 a woman.

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 have an 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 position of the patient lying on his back, 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 ​​the spine or of a shooting character, radicular pain, which disappears soon after the cessation of compression of the aorta. Often, in addition to this, patients note paresthesias in the legs (numbness, tingling, vibration, feeling of coldness) and / or in the back.

The presence of a symptom of a venous push check also with the patient supine. When squeezing the inferior vena cava at the level of the umbilicus on the right, local pain and / or conduction-segmental paresthesias occur in the lower half of the body. 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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Acute violation of the spinal circulation with the development of ischemia / hemorrhage. It is manifested by acutely arising motor disorders of the central and peripheral type, a decrease in various types of sensitivity, a disorder of the function of the pelvic organs. The diagnosis is established on the basis of clinical data, the results of tomography, angiography, analysis of cerebrospinal fluid, electroneuromyography. Conservative therapy is carried out differentially in accordance with the type of stroke. To remove a blood clot, aneurysm, restore the integrity of the vessel, surgical intervention is required.

General information

Spinal (cerebrospinal) stroke occurs much less frequently than cerebral circulation disorders. The reason becomes clear taking into account the ratio of the masses of the spinal cord to the brain, which is approximately 1:47. Among all acute disorders of CNS hemodynamics, spinal stroke occurs in 1-1.5% of cases. Most often, the disease is diagnosed in the age period of 30-70 years. Both males and females suffer equally often. The vast majority of spinal cord strokes are ischemic in nature. The largest number of lesions occurs in the lumbar, lower thoracic spinal segments.

Spinal Stroke Causes

The main causes of acute disorders of the cerebrospinal circulation are thromboembolism, compression, prolonged spasm, rupture of the vessels providing spinal blood supply. The etiofactors provoking a vascular catastrophe are numerous and varied. The multifaceted etiology has led to the division of factors causing spinal stroke into two main groups.

Primary vascular lesions:

• Spinal anomalies: arteriovenous malformations, aneurysms, kinks. They are quite rare. They create obstacles that slow down blood flow. Thinning of the vascular wall in the area of ​​the aneurysm, malformation provokes its rupture with the development of hemorrhagic stroke.
• Vascular wall changes: atherosclerosis, amyloidosis, varicose veins, vasculitis. Atherosclerosis of the aorta and spinal arteries is the most common cause of ischemic spinal stroke. Violation of the blood supply occurs due to a decrease in the lumen of the arteries due to the formed atherosclerotic plaques, blockage of blood vessels by masses detached from the plaque.
• Vascular damage... A rupture of the vessel is possible with spinal cord injury, damage to the vascular wall by a fragment due to a spinal fracture. Iatrogenic injuries that complicate lumbar puncture, spinal anesthesia, and surgical interventions in the spine are extremely rare.

Secondary hemodynamic disorders:

• Spinal column pathology: spinal malformations, osteochondrosis, spondylitis, intervertebral hernia, spondylolisthesis. A change in the mutual anatomical arrangement of the structures of the spinal column due to an anomaly, displacement of the vertebrae causes compression of the spinal vessels. Osteophytes, disc herniation also cause compression of adjacent vessels.
• Tumors of the spinal cord and spine. As the neoplasms grow, they put pressure on the nearby vessels, reducing their lumen. Malignant tumors can invade the walls of blood vessels, provoke their thinning, destruction, leading to hemorrhage.
• The defeat of the spinal membranes: arachnoiditis, meningitis. The inflammatory process spreads to the spinal vessels. Vasculitis leads to increased permeability, violation of elasticity, the formation of thrombotic deposits in the area of ​​the affected area of ​​the vascular wall.
• Diseases of the blood: hemophilia, leukemia, coagulopathy, thrombocythemia. They are accompanied by a violation of the rheological properties of blood, hemostatic mechanisms. Hemorrhagic spinal stroke occurs due to bleeding at the slightest vascular damage, ischemic - due to increased thrombus formation.

In many cases, a spinal stroke develops as a result of the realization of several reasons at once. The likelihood of pathology increases in the presence of contributing circumstances. The most significant predisposing factors are arterial hypertension, obesity, hyperlipidemia, physical inactivity, and smoking.

Pathogenesis

The cervical, upper thoracic segments of the spinal cord are supplied with blood by the system of vertebral arteries originating in the subclavian artery. Blood supply from the fourth thoracic segment to the sacral region, inclusive, is carried out by intercostal, lumbar, sacral vessels coming from the aorta. The internal iliac artery provides blood circulation in the cauda equina region. Vessels approaching the spinal cord as part of the spinal roots give rise to radiculomedullary arteries, the number of which varies from 5 to 16. Radiculomedullary vessels form numerous anastomoses that form the anterior spinal artery along the anterior surface of the brain, and 2 posterior arteries along the posterior surface. The variability in the number and location of radiculomedullary arteries makes it difficult to determine the localization of the vascular problem.

Local disturbance of the passage of blood in the vessel (due to blockage, compression, spasm, rupture) causes hypoxia (oxygen starvation), dysmetabolism of neurons in the blood supply area, the formation of a hemorrhage zone. In acute development, these disorders do not have time to be compensated for by collateral circulation, metabolic restructuring. As a result, there is a dysfunction of the neurons in the area of ​​the spinal substance. A zone of ischemia / hemorrhage is formed, which subsequently transforms into a zone of necrosis (death of neurons) with the formation of an irreversible neurological deficit.

Classification

Spinal stroke can have several etiopathogenetic variants. Understanding the developmental mechanisms that form the basis of a specific case of a disease is of fundamental importance in clinical neurology. In this regard, the main classification of spinal strokes is based on the pathogenetic principle and includes three types of stroke:

• Ischemic (heart attack). It is caused by spasm, obliteration, compression of one / several arteries supplying the spinal cord with the formation of an ischemic area in the substance of the spinal cord.
• Hemorrhagic. It occurs due to rupture, damage to the vessel wall. Hemorrhage in the parenchyma of the spinal cord is called hematomyelia, in the membranes - hematorchis.
• Mixed. Hemorrhage is accompanied by reflex vascular spasm with the formation of a secondary ischemic zone.

According to the morpho-pathogenetic mechanisms of the development of the disease in its course, four periods are distinguished:

• The stage of harbingers... Typical for ischemic stroke. It is manifested by transient episodes of back pain, movement, sensory disorders.
• Stroke development stage(stroke in progress) - the period of progression of pathological changes: expansion of the ischemic focus, continuation of bleeding. Clinically accompanied by an increase in symptoms.
• Reverse development stage... Therapeutic measures stop the progression, the restoration of the function of the surviving neurons begins. The severity of neurological deficit gradually decreases.
• Stage of residual consequences... It is caused by incomplete restoration of lost functions due to mass death of neurons. Residual post-stroke symptoms are persistent for life.

Spinal Stroke Symptoms

Symptoms occur suddenly within minutes, less often hours. Ischemic spinal stroke in some cases has a prodromal period in the form of episodes of intermittent claudication, paresthesias, periodic pain in the spine, symptoms of sciatica, transient pelvic disorders. At the onset of the disease, a gradual increase in symptoms is possible. Pain syndrome is uncharacteristic, on the contrary, damage to the sensory zones of the spinal cord leads to the disappearance of pain sensations noted during the period of precursors.

The manifestation of hematomyelia occurs after injury to the spine, physical activity, accompanied by a rise in body temperature. Typical is a sharp dagger pain in the spinal column, radiating to the sides, often taking on a girdle character. Hematorchis proceeds with irritation of the meninges, the spread of the process to the membranes of the brain causes the appearance of cerebral symptoms: cephalgia, dizziness, nausea, depression of consciousness.

Spinal stroke is characterized by a large polymorphism of the clinical picture. Neurological deficit depends on the localization, the prevalence of the process across the spinal cord and along its length. Movement disorders are characterized by flaccid peripheral paresis at the level of the lesion, central spastic paresis below the affected segment. Peripheral paresis is accompanied by muscle hypotonia, hyporeflexia, which subsequently leads to muscle atrophy. With central paresis, spastic muscle hypertonia, hyperreflexia, and contractures are possible. Localization of the affected area in the cervical segments is manifested by flaccid paresis of the upper limbs and spastic lower ones, in the thoracic segments - by central lower paraparesis, in the lumbosacral - by peripheral paraparesis.

Sensory disturbances occur below the level of the lesion, depending on the localization of the stroke focus across the spinal cord. With extensive spinal stroke with pathological changes along the entire spinal diameter, there is a loss of all types of sensitivity, pelvic disorders, and bilateral motor deficits. Involvement of half the diameter leads to the development of Brown-Séquard syndrome: motor disorders, loss of deep sensitivity are revealed homolaterally, disturbances of superficial (pain, temperature) perception are detected heterolaterally.

With the defeat of the ventral half (a catastrophe in the anterior spinal artery), motor disorders are accompanied by loss of pain, retention of urine, feces. Tactile, muscular-articular perception is preserved. Dorsal stroke (pathology of the posterior spinal artery) is rare, manifested by Williamson's syndrome: spastic paresis, sensitive ataxia, segmental hypesthesia, loss of vibration sensitivity of the lower extremities. An isolated lesion of the anterior horn is characterized by the presence of only one-sided peripheral paresis.

Complications

A spinal stroke is characterized by movement disorders that, without appropriate treatment, transform into persistent limitations of motor function. Patients lose the ability to move freely, with spastic paresis, the situation is aggravated by the development of joint contractures. In the case of severe tetraparesis, patients are bedridden. Immobility is dangerous by the development of bedsores, congestive pneumonia. Pelvic disorders are complicated by an ascending urinary tract infection: urethritis, cystitis, pyelonephritis. The addition of infectious complications can lead to sepsis with a threat of death.

Diagnostics

Diagnostic measures begin with taking anamnesis. The presence of the stage of precursors, acute / subacute onset, the sequence of the development of symptoms matters. The motor / sensory deficit revealed during the neurological examination allows the neurologist to suggest a topical diagnosis, however, the variety of individual variants of spinal blood supply makes it difficult to determine the site of vascular occlusion or rupture. In order to clarify the diagnosis, instrumental studies are carried out:

• Spine tomography... Computed tomography allows you to determine the displacement, damage to the vertebrae, the presence of fragments, osteophytes, narrowing of the intervertebral fissure. MRI of the spine better visualizes the spinal cord, makes it possible to diagnose intervertebral hernia, compression of the spinal canal, spinal tumor, hematoma.
• Lumbar puncture... In 30% of patients, the examination of the cerebrospinal fluid does not reveal abnormalities. In most patients at the stage of development of pathology, an increase in protein concentration up to 3 g / l, pleocytosis of 30-150 cells in 1 μl is observed. The hemorrhagic variant is accompanied by the appearance of erythrocytes in the cerebrospinal fluid.
• Spinal angiography. It is carried out to identify aneurysms, malformations, thrombosis, compression of the vessel from the outside. A simpler, but less informative study of spinal blood circulation in the thoracic and lumbar regions is

  With this disease, urgent therapeutic measures are required. Early initiation of therapy allows you to stop the expansion of the spinal lesion zone, prevent neuronal death. Complex conservative treatment is carried out, corresponding to the type of stroke:

  • Non-specific therapy. It is prescribed regardless of the type of stroke, is aimed at reducing edema, maintaining the metabolism of neurons, increasing the resistance of spinal tissues to hypoxia, and preventing complications. It is carried out with diuretics (furosemide), neuroprotectors, antioxidants, B vitamins.
  • Specific therapy for ischemia... Improvement of blood circulation in the ischemic zone is achieved by using vasodilating, disaggregating, microcirculation-improving agents. For thromboembolism, anticoagulants are indicated: heparin, nadroparin.
  • Specific therapy for hemorrhage... It consists in the use of hemostatic pharmaceuticals: vicasol, epsilonaminocaproic acid. Additionally, angioprotectors are prescribed to strengthen the walls of the vessels.

  In case of rupture of a vessel, compression by a tumor, thromboembolism, surgical treatment is possible. Operations are performed by neurosurgeons, vascular surgeons on an emergency basis. The list of possible surgical interventions includes:

  • Reconstructive vascular surgery: thromboembolectomy, stenting of the affected vessel, suturing / clipping of the vascular wall defect.
  • Elimination of angiodysplasia: excision of the malformation, ligation / hardening of the adductor vessels, resection of the aneurysm.
  • Eliminate compression: removal of extra- / intramedullary spinal tumor, discectomy for hernia, fixation of the spine.

  In the recovery period, rehabilitation doctors use the entire arsenal of tools for the early restoration of lost neurological functions. Physiotherapy exercises, massage, physiotherapy are prescribed. The improvement of the conduction of nerve fibers is facilitated by electromyostimulation, the restoration of voluntary control of urinary function - electrostimulation of the bladder.

  Forecast and prevention

  A spinal stroke is not as life-threatening as a cerebral stroke. A lethal outcome is possible with malignant neoplasms, a severe general somatic background, and the addition of a secondary infection. Timely treatment contributes to the rapid regression of symptoms. The vastness of the affected area, late start of treatment, concomitant pathology cause incomplete recovery, disability of the patient due to persistent residual paresis, pelvic, sensory disorders. The prevention of the disease is based on the timely treatment of vascular diseases, the identification and removal of malformations, the treatment of intervertebral hernias, and the prevention of spinal injuries. The exclusion of predisposing factors is of great importance: maintaining an active lifestyle, normalizing weight, balanced nutrition, quitting smoking.

Acute occlusion of the vessels of the spinal cord, as a result, impaired blood circulation, is called a spinal stroke. Most often, it manifests itself in the form of a spinal vascular infarction, only 10% have open hemorrhage. The disease is rather rare compared to a cerebral stroke. Nevertheless, in our time, 9 out of 10 cases fall into the age range from 30 to 70 years, men and women are the same.

The cause of the occurrence lies in the excessive load on the nervous system, damage to the extraspinal vessels or congenital aortic pathology. And also - suffered myocardial infarction, systemic drop in blood pressure, osteochondrosis and vertebral hernia.

Varieties of spinal stroke

The doctor's prognosis implies a differential diagnosis between several parallel disorders of the central nervous system - myelitis, epiduritis, tumors with metastases. In each of the cases, an analysis is taken for an increased ESR, a myelogram is performed. When a spinal stroke is detected, several varieties are classified:

1. Ischemic - most often the causes are blood clots, circulatory disorders in the aorta, hernias and tumors.
2. Hemorrhagic - means a hemorrhage that has occurred. It develops as a result of vascular pathology, blood diseases, and also due to tumors.
3. Mixed

With any stroke, the destruction of gray and white matter, death of tissues and neurons occurs.

The first signs and course of the disease

Most often, with a spinal stroke, the cervical thickening or the lower part of the spinal neurons, located below the rib cage, is affected. The disease begins to manifest itself with sharp, unreasonable back pain and muscle cramps. This is not yet the course of a stroke, but an aggravated osteochondrosis and, as a result, a developed intervertebral hernia. Next, doctors diagnose the following symptoms:

• The appearance of weakness in the legs, a drop in the threshold of sensitivity;
• Stool problems: acute constipation or, conversely, diarrhea, frequent and uncontrolled urination;

Sometimes, on the contrary, urinary retention occurs. If the patient did not notice any problems with the work of the genitourinary organs, with such an irregularity, a prognosis should be made.

• Sharp pains in the upper part of the spine, in the lower thoracic region;
• Feeling of "goosebumps" between the shoulder blades, numbness or paralysis of the muscles of the back;
• Leg pain, lameness.

Ultimately, paresis or paralysis of the lower extremities occurs, and incontinence of defecation and urination is fixed.

Doctors define four stages in the course of disease:

• Precursor- pains, weakness, lameness in the legs and back pain only make themselves felt. If a spinal hernia is diagnosed, the likelihood of a spinal stroke increases several times.
• Development- proceeds according to the symptoms described.
• Reverse development of the disease- in the course of correct treatment, it is possible to reverse the symptoms, completely or partially get rid of paralysis.
• Residual phenomena.

Each of these stages occurs individually for each.

First aid and diagnostics

When precursors or the first obvious symptoms of a spinal stroke appear, it is necessary to force the patient to take a horizontal position. Lie on your back on a hard surface, then you need to call an ambulance. Doctors are obliged to transport the patient on a shield or a hard stretcher. During the diagnosis, doctors are required to perform:

• Spinal cord magnetic resonance imaging;
• A blood test to detect ESR and general diseases;
• Electroneuromyography;
• Parallel diagnostics of myelitis and tumors, hernia.

Treatment

The final recipe for recovery and the course of treatment will depend on the type of stroke, the form of the disease. Treatment is carried out in a hospital, the patient must comply with bed rest. Intravenous drugs are taken to improve blood circulation and blood pressure.

The most important thing is to eliminate the cause of the stroke. Whether it's a blood clot, a hernia or a tumor, a blood disorder, blood-thinning drugs, antibiotics are prescribed, and if necessary, surgery. Muscle spasm is relieved by muscle relaxants. Often, doctors are able to fully restore the sphincters, the sensitivity of the lower extremities and achieve complete recovery. Unfortunately, some patients will require lifelong care and bed rest after illness. Post-factum: after treatment, the patient must wear a surgical corset for some time, attend therapeutic massage and physiotherapy.

Prevention and lifestyle

In order to prevent the recurrence of the disease, or to initially save yourself from risk, it is recommended to focus your activities on getting rid of the causes. So, by watching your food, doing gymnastics and sports that are beneficial for the back muscles, giving up bad habits, the risk of developing a spinal stroke can be reduced by 90%.

Please note: patients who have suffered from this disease are assigned a degree of disability, which entails the selection of an appropriate job.

If sedentary work or regular heavy lifting puts too much stress on the spine, do not neglect wearing a support corset. It is recommended to undergo an examination at least once a year, and for recovered patients - also sanatorium treatment, massage courses. Antihypertensive medications should be taken as directed by your doctor. By carefully following all the prescriptions, you can maintain health and full mobility.

You are at risk if:

• experiencing sudden headaches, flashing flies and dizziness;
• pressure "jumps";
• feel weak and get tired quickly;
• annoyed over trifles?

These are all harbingers of a stroke! E. Malysheva: “Signs noticed in time, as well as prevention in 80% helps to prevent a stroke and avoid dire consequences! To protect yourself and your loved ones, you need to take a penny ... "