Duggal & Lach (2002). Selective vulnerability of the lumbosacral spinal cord after cardiac arrest and hypotension

[Wise Young]

Duggal N and Lach B (2002). Selective vulnerability of the lumbosacral spinal cord after cardiac arrest and hypotension. Stroke. 33 (1): 116-21. Summary: Background and Purpose- It is generally accepted that the gray matter in the watershed area of the midthoracic level of the spinal cord is the ischemic watershed zone of the spinal cord. We performed a retrospective study to reevaluate the frequency and distribution of spinal cord injury after a global ischemic event. METHODS: Clinical files and neuropathology specimens of all adult patients with either a well-documented cardiac arrest or a severe hypotensive episode, as well as pathologically confirmed ischemic encephalopathy and/or myelopathy, were reviewed by an independent reviewer. RESULTS: Among 145 cases satisfying selection criteria, ischemic myelopathy was found in 46% of patients dying after either a cardiac arrest or a severe hypotensive episode. Among the patients with myelopathy, predominant involvement of the lumbosacral level with relative sparing of thoracic levels was observed in >95% of cardiac arrest and hypotensive patients. None of the examined patients developed neuronal necrosis limited to the thoracic level only. CONCLUSIONS: Our findings indicate a greater vulnerability of neurons in the lumbar or lumbosacral spinal cord to ischemia than other levels of the spinal cord. <http://www.strokeaha.org/cgi/content/full/33/1/116
http://www.strokeaha.org/cgi/content/abstract/33/1/116
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11779899> Department of Clinical Neurological Sciences (Neurosurgery), University of Western Ontario, London, Ontario (N.D.), and Department of Laboratory Medicine and Pathology, University of Ottawa and Ottawa Hospital, Ottawa (B.L.), Canada.