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Thread: dr. young- infarction

  1. #1
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    dr. young- infarction

    dr. young- when a avm causes venous congestion and subsequent swelling, is this known as a infarction? That's what basically happened to me. I believe sue p. suffered the same thing?. here's the million dollar question- what level would the area just above the conus be? I lost function from bottom up- loss of bladder- up to legs overnight. avm was on anterior pial surface, fed by the anterior spinal artery. It was so small, that neuro's had hard time fin ding it, even during a angiogram. So tell me Dr. Young- in the ultimate catch-22, am I screwed? Someone with a higher thoracic and cervical injury has a better chance of recovery? All this time I was told that I was lucky it hit so low. Finally, the fact that I have leg muscle return, but no bowel and bladder, I assume I am complete. I cannot believe the deep mess I am in!

  2. #2
    Super Moderator Sue Pendleton's Avatar
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    An AVM was ruled out somewhere along the way with me Chris. I think the first contrast MRI did it but I won't swear to that. My lesion also was very small but it was also higher up in the cervial area about C4. Whether an infarct caused transverse myelitis or transverse myelitis caused my infarct is the current question I hear.. My paralysis began at the top and went relentlessly downward.

  3. #3
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    sue p.

    sue- if i may ask, what has returned mu8scle and sensation wise? what do you feel would need to be done in the future to promote recovery? Sorry, these are just random questions

  4. #4
    Chris Durfee,

    An arteriovenous malformation (AVM) is a situation where an artery mistakenly connects directly to a vein. When this happens, blood that normally should go into the capillaries shunt instead into the veins. This alone may produce a small infarct (tissue damage). However, if the arterial blood going into the venous system causes an increase in venous pressure, this slows blood flow for a much larger region. Venous pressure goes up and this opposes blood flow from other arterial blood. The veins enlarge (called venous congestion). In fact, the presence of venous congestion is the most common manifestation of a small AVM and neurosurgeons often can have trouble finding a small AVM.

    The degree of damage differs considerably because blood flow patterns are so variable and different between people. Because you have gotten muscle function back in your legs, this suggests that the ischemia spared your lumbar cord but it may have affected your sacral cord. Please note that the levels of spinal cord are not the same as the levels of your vertebral segment. Most of the upper lumbar cord is present in the lower thoracic spinal segments (T11-12) and the lower lumbar and sacral cord is present at the L1 spinal segment level.

    I think too much ado has been made over the concept of "complete" and "incomplete" spinal cord injury. As I have suggested in many other postings, I do not believe that "complete" loss of function means that there is no more spinal cord connections. In your case, most of the damage is probably to gray matter in the sacral cord rather than the white matter.

    In terms of what therapies may restore function to you, keep two things in mind. First, several studies (from Gearhart and others) suggest that stem cells can replace neurons in the spinal cord. Second, the spinal cord itself has stem cells and your endogenous stem cells probably accounted for some or much of the recovery that you have had since your injury. So, the future holds much promise for restoring function to people who have lost neurons in their lower spinal cord.

    Three years ago, I would not have been as optimistic because we did not know that there were stem cells in the cord that can produce new neurons and also the studies showing the stem cells can produce new neurons in the spinal cord had not yet been reported. This is one of the reasons why I regard stem cells to be an important area of research that must be pursued.

    Wise.

  5. #5
    Super Moderator Sue Pendleton's Avatar
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    Chris, my ischemia resulted in anterior spinal artery syndrome. While I had to be intubated for about the first week because I couldn't breath on my own I never lost light touch, vibation or propriosensations. Over the years I've gotten a lot of muscles and more sensation back. I have been able to bear weight and doing standing transfers for several years and the 4-AP helped me increase muscle strength and also to locate muscles that were innervated but too weak to use. Do a search for me and 4-AP and my very oft repeated dull story is in there several times. I also think that extended physical therapy and things like supported ambulation training can do wonders at retraining what I think is a very plastic and teachable spinal cord (no, I don't think just trying harder will make someone with no innervation move againor get them off ventilators).

    I think that anything that helps with remyelination will help me reach what has been my first goal--to be functionally independent in my own home. I've seen som,e interesting studies using OEGs and/or schwann cells to do just that in pre-clinical models.

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