Bolt Burdon Kemp: What is a spinal stroke?

Introduction  

A spinal stroke involves either a stroke in the spinal cord, or the blood vessels supplying it. The disruption of blood supply to the spinal cord causes tissue damage, which affects nerve impulses’ ability to travel through the spinal cord. This in turn affects the functions of the central nervous system.

Spinal strokes are relatively rare, and are thought to account for only about 1.25% of all strokes.

This blog is intended as an introduction to the issue, and is not comprehensive of all the causes and issues surrounding spinal strokes. All patients will be affected differently, and only a treating doctor is able to provide specialist advice regarding an individual’s condition.

Causes 

A spinal stroke can be caused by either a blockage of a blood vessel/s (ischaemic strokes), or by a bleed (haemorrhagic strokes). 

Ischaemic stroke is the most common cause of a spinal stroke, and is commonly caused by thickening or closure of the arteries due to accumulation of fatty deposits. This is a specific type of artherosclerosis, which is arterial disease, similar to the causes of heart attacks, and also strokes affecting the brain, (where the blood supply to tissue is also disrupted due to the arteries becoming narrowed or completely blocked).

The two main arteries supplying the spinal cord are the anterior spinal artery and the posterior spinal artery, which are at the front and back of the spinal cord. It is more common for interruption of the blood supply to the anterior spinal artery to be the cause of a spinal stroke. This is most often caused by insufficiencies with the branch of the aorta which provides the blood supply to the anterior spinal artery. As well as arteriosclerosis described above, aortic aneurysms, trauma to the aorta, surgical injuries, and acute disc herniation can affect the blood supply.

Haemorrhagic spinal strokes can be caused by a blood vessel bursting. High blood pressure increases the risk, as it weakens and damages the arteries, making them more susceptible to tear. Haemorrhagic strokes can also be caused by aneurysms, which are swellings of the arteries, much like a balloon, which may eventually burst if not treated.

Other causes of spinal strokes include trauma to the spinal column, abnormally tangled blood vessels, known as arteriovenous malformations (AVMS), vasculitis, decompression sickness, and sickle cell disease, amongst other conditions.

Symptoms

Symptoms of a spinal stroke generally appear within minutes or a few hours of the stroke occurring, and may include:

• Intermittent sharp or burning back pain
• Aching pain down through the legs weakness in the legs 
• Problems with bowel and bladder including incontinence, and increased need to go to the toilet.
• Loss of pain and temperature sensation
• Muscle weakness in the legs, which can progress to paralysis
• Muscle spasms in the leg. 
• As with other spinal-cord injuries, the symptoms will begin at the level of the injury and affect the area and functions controlled by the spinal cord below that point.

Tests and Diagnosis

The symptoms of a spinal stroke can be similar to other conditions, including other causes of spinal-cord injury, and so tests are needed to identify the cause. 

The key test to identify a spinal stoke is a MRI scan (Magnetic Resonance Imaging scan) of the spine, which can identify a disrupted blood supply, but can also be used to rule out other causes of spinal-cord damage.

Treatment

The treatment for a spinal stroke depends on its cause: Strokes caused by a blockage of the arteries may be treated by blood thinning drugs. If the stroke has been caused by high blood pressure or cholesterol levels, then medication can also be used to treat these causes. 

It is obviously important for spinal strokes to be diagnosed and treated as soon as possible, to try and reduce the damage caused to the spinal cord. 

The severity of injury depends on the severity of damage to the spinal cord, and the level of the injury. Whilst some patients’ symptoms will improve following treatment and rehabilitation, many will be left with permanent symptoms. For those with longer-term symptoms, specialist rehabilitation services are available, and patients can benefit from the input of physiotherapists, occupational therapists, continence specialists, clinical psychologists or counsellors, amongst other specialities.

Information and support is available from the Spinal Injuries Association for those affected by all types of spinal-cord injury, including spinal strokes. For example, the Spinal Injuries Association provides a range of ‘Peer Services’ (https://www.spinal.co.uk/page/peer-services) to support those learning to adapt to a spinal-cord injury.

Ruth Hewitt is a senior solicitor at Bolt Burdon Kemp and specialises in clinical negligence claims and has years of experience of acting for seriously injured clients.

‘If you are concerned that the medical treatment you have received has caused you an injury, whether due to a delay in diagnosing a condition or in the way it was treated, contact us online or call 0808 1596 075 for expert advice from our dedicated team. 

Ruth Hewitt 

Senior Solicitor 

DDI +4420 7288 4810
Mobile: +447557 804715
Bolt Burdon Kemp
Providence House, Providence Place, Islington, London N1 0NT
www.boltburdonkemp.co.uk
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References:

http://www.ninds.nih.gov/disorders/spinal_infarction/spinal_infarction.htm

http://stroke.ahajournals.org/content/29/1/239.full

http://en.wikipedia.org/wiki/Anterior_spinal_artery_syndrome

http://www.brainandspine.org.uk/spinal-strokes?gclid=CPOQlJf_pb4CFagEwwodwZcAKw