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  1. #1

    Spinal stroke?

    Hello, i am writing here hoping somebody on here can and will give me some advice. My partner melissa(32) recently went for a day case op. She had a general. When she came out of the op she had pins and needles then paralysis of the legs, can actually wiggle her toes slightly. The only problem with this op was that her blood pressure dropped to a very low level, this level unknown at the moment as i have not seen the notes. My partners blood pressure is normally around 90 over 40. This is easily fixed by placing her on a drip. I was wondering if you would agree with me that it was a spinal stroke and also ignoring what was the cause what would you say should be the way forward? Nothing showed on 3 MRIs or a ct scan.This is now week 5, she is in a stroke ward and is recieving physio twice a day. The physio only started 2 weeks ago. They are now talking about sending her home which obviously would mean less physio. As far as my limited knowledge goes this is the only thing that may get her back on her feet,true? Also we have been told the first 8 weeks are the most important hence the move home should not be considered. Anybody out there have any answers for me. Regards Frustrated partner.

  2. #2
    We need more information here.

    A "watershed" stoke of the brain or cord can occur in those whose blood pressure drops very low, but it is unusual in someone who already has a low blood pressure.

    What type of surgery was it?

    How much paralysis does she have currently? Which muscles?
    What is her ASIA score and category?
    Does she have bowel and bladder impairment?
    Did they rule out a spinal cord AVM?
    When you say the MRI was normal, did this include a lack of any signs that the spinal cord had been infarcted? Usually this shows up on an MRI within a few days to weeks.
    Where is she now (country, city, as well as facility)?
    Have you asked about sending her to a major SCI specialty rehabilitation facility?

    (KLD)

  3. #3
    Hello, they have told us that her blood pressure had dropped to low level for 10 minutes. Watershed?
    She was having a Laparoscopy.
    Paralysis is of legs. Small wiggling of toes. Nuerosurgeon say this should not be with a spinal stroke! Incomplete-complete?Total control of bowels and bladder.

    Asia Score and category?
    Avm?
    No obvious signs in all 3 MRIs.
    She is in Raigmore hospital, Inveness, Scotland(UK)She is being cared for in a stroke unit!
    She was flown to glasgow 200 miles away to go to the only spinal unit in Scotland. Went to neurological ward first for assessment and supposedly to go the spinal unit afterwards to be assessed there, she never got there. One doctor actually said there was no reason for her to go there as it was for serious injuries this was before he had looked at her. Not being able to walk must be a minor ailment. They decided they could look after her in Inverness. I disagree.They have never seen the injury before never mind treated it. Help,advice?

  4. #4
    You are going to have to be insistant that she go back to the spinal cord injury unit.

    ASIA = American Spinal Injury Association assessment tool. It is standardized throughout the world.

    AVM = arteriovenous malformation, a common cause of spinal cord stroke in young people.

    Watershed stroke = one that occurs because the blood pressure dropped so low that the tissues were not perfused (supplied with oxygen).

    It is possible to have a spinal stroke and move your toes, with paralysis higher. This is called sacral sparing.

    (KLD)

  5. #5
    I thank you for your quick reply. I will be seeing the doctors tomorrow. My problem with asking for her to be sent back to the Spinal unit is that she is no need for any medical care(?) Or from the outside it looks like this. I will let you know how we get on. Thank you again

  6. #6
    She needs specialty SCI rehabilitaiton services as an inpatient.

    Doesn't she have some bowel and bladder impairment too?

    (KLD)

  7. #7
    I totally agree. I am not too sure if mentally it is the best thing as she has a young family. I want her to go she does not. Although she will if told by a professional that it is best. She has no problems with her bowels or bladder, none. I will let you know how we get on. thank you

  8. #8

    help

    Hello again, today the doctor has said that she was dissapionted in the progress made and thinks melissa should be sent home and brought back later. The theory being that physio will not get her legs to work they will just work whenever so the physio is not doing anything.. Maybe with time at home her legs will work then they will get her in for more physio.If her legs were working i would have her home now as i have people around me to get her physically fit again! I wonder do these people know what they are doing?

  9. #9
    Super Moderator Sue Pendleton's Avatar
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    Was the laporascopy done using an epidural? Has she had a spinal tap? If she had a stroke due to an epidural the sooner she has rehab the better the outcome. If she acquired an infection, bacterial or viral, in her spinal fluid it needs treated immediately.

    Unless those docs can tell you why they think your partner's legs will recover on their own they're not helping they're hurting. If she sits or lays in bed all day she will lose muscle mass. That's why rehab is so important early on.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  10. #10
    Quote Originally Posted by melissa76
    I totally agree. I am not too sure if mentally it is the best thing as she has a young family. I want her to go she does not. Although she will if told by a professional that it is best. She has no problems with her bowels or bladder, none. I will let you know how we get on. thank you

    Melissa, I am a spinal cord injury researcher. Four parts of your description strongly argue against a spinal stroke.

    1. "She has no problems with her bowels or bladder, none." In my opinion, this statement alone throws the spinal cord stroke diagnosis out the window. Let me explain why. A spinal stroke that causes injury to the thoracic spinal cord and that causes paralysis in the legs must have affected the long tracts. Your partner should have problems with bladder control. The fact that she did not have any problem with her bladder at any time indicates that she did not have spinal cord injury.

    2. The above is consistent with the absence of any MRI findings in her spinal cord. A stroke usually causes a rather big increase in MRI intensity at the infarct site. If none can be seen, there is unlikely to be a stroke.

    3. You are not describing any of the other symptoms of spinal cord injury, symptoms that are usually apparent by this time, including spasticity (if there is no spasticity, there should be substantial atrophy).

    4. You don't describe a sensory level in the belly, butt, or other parts of the anatomy. A sensory level is where there is sensation above and no sensation below a given level. A spinal cord injury should cause a prominent sensory level and most people would describe such a level.

    I suspect that your partner did not have a spinal cord injury. It sounds like it was more like nerve compression or perhaps even peripheral neuropathy. By the way, a drop in blood pressure normally would not cause a spinal cord infarct, without severe brain damage. The brain is much more sensitive to reduced blood flow than the spinal cord. So, if she has had no brain damage, it is very unlikely that the episode of hypotension had any effect on her spinal cord.

    I don't know what she has. My guess, based on the limited history that you have given including the fact that she has cancer and may be receiving chemotherapy, is that the cancer or chemotherapy may have caused a peripheral neuropathy that was aggravated by the hypotension. The way that you would find out is to do a neurological examination and to look for reflexes. The deep tendon reflexes should be depressed with peripheral neuropathy but increased with spinal cord injury. Electrophysiological study of the peripheral nerve should show decreased conduction velocity in the peripheral nerves and should be able to separate out sensory or motor neuropathy, if there is a difference.

    The differential diagnosis should be cauda equina injury, diabetes, and Guillian-Barre or a viral-induced peripheral neuropathy.

    Wise.

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