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Thread: ischemia or other vascular causes of SCI

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    ischemia or other vascular causes of SCI

    Last night's episode of House was about a paraplegic of two years who was cured after another health problem lead doctors to the discover the misdiagnosis of his SCI. It turned out his SCI was caused by some sort of vascular or AVM problem.

    The patient had so much swelling during the initial onset that the AVM was hidden from all the tests and MRI. It was only because of the anti-inflammatory effect of the steroids he was given for the other health problem that they were able to find the AVM.

    I know it's just a TV show and I'm obviously not a doctor but wouldn't there be clues in the bloodwork to show signs of stroke or any other vascular causes of SCI?

    Would fixing the AVM 2 years post-injury help a paraplegic walk?

    I'm curious becuase I'm a T8 of 3 years post and still am not sure exactly what happened to me. The Doctors suspect some sort of ischemic event.

    "My legs hurt like hell sometimes but if I don't think about it, it goes away."

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    Super Moderator Sue Pendleton's Avatar
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    I love that show. Which means that it will be cancelled. They also had an episode where a guy fell mountain climbing and nothing showed on MRIs or CTs but paralysis was climbing up his body (ok, so somethings are wrong). They found an embolism caused by a contusion injury when the guy went into AD while he was in the OR for an exploratory..

    As for AVMs? Hard to tell. Is the T8 diagnosis based on MRI? Or is it from functional testing and being poked with needles and prodded with a tuning fork? If only from functional tests I'd probably take the risk and have an angiogram done. If your MRI showed something but a lumbar puncture was clear you might have had a stroke or TM. If you haven't had a lumbar puncture get ready for serious headache pain. At T-8 I think I might want a cardiologist to sit in on a review of your case.

    Sorry. Couldn't resist. I'm thinking of going back to school.

    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

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    I lost count of how many MRIs and LPs I have had in the past 3 years. All I ever got is. "there appears to be swelling between t8-t10".

    I had the needle tests too but I think the T8 is a MRI T8.

    By the way the taps weren't clean, high myelin basic protein among some RBCs and WBCs. That lead to the initial TM diagnosis. However, onset was probably around 30 minutes and happened while surfing (didn't fall or crash). Kerr from TM Center in Hopkins didn't think it was TM and felt it was stroke or some sort of physical trauma.

    Why a cardioligist for T8?

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    my avm was fixed 6 weeks after onset of paraplegia and I cannot come close to walking, standing, urinating without catheter, and having a orgasm or erection. Most spinal avms start with stuttering paralysis, giving doctors and the patient time before full blown paraplegia starts.

    sherman brayton

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    Due to an aorto rupture in a MVA (1996), i suffered a spinal infarct at the T10 level. I've been an incomplete paraplegic ever since.

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    Super Moderator Sue Pendleton's Avatar
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    Originally posted by walkanotherday:


    By the way the taps weren't clean, high myelin basic protein among some RBCs and WBCs. That lead to the initial TM diagnosis. However, onset was probably around 30 minutes and happened while surfing (didn't fall or crash). Kerr from TM Center in Hopkins didn't think it was TM and felt it was stroke or some sort of physical trauma.

    Why a cardioligist for T8?
    I'm not about to contradict my neurologist. LOL I suggested the cardiologist because the main artery to the spine is in the T-8 region. If you had no other tests that indicated a reason then maybe an heart doc might have a clue. How high was you myelin basic protein? Higher than 9?

    My infarct was also fast. Looking back at the CT from Ulm of my brain and the time stamp on it; I went from fine to unable to move below the neck within an hour. Maybe 90 minutes. Intubated after maybe another 15 to 30 minutes. But my taps were clean except the first had a few RBCs the doc recorded as being from the procedure itself.

    And yes, not knowing what caused it drives me nuts!

    Sherman, you didn't have any stuttering?

    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

  7. #7
    walkanotherday,

    There is no blood test that I know that would be able to distinguish between a stroke, TM, or other causes of injury to the spinal cord.

    The definite test for an arteriovenous malformation (AVM) is to do an arteriogram (a x-ray of the blood vessels after contrast injection). While it is possible to detect an AVM from the presence of enlarged veins in the spinal cord, this may miss some small AVM's.

    If you have an AVM and continuing ischemia (low blood flow in the spinal cord), treatment of the AVM may restore some function. I have participated in studies of patients with AVM's where fixing the AVM by embolization have restored some function even though the person may have been paralyzed for many years.

    The spinal cord receives a portion of its blood supply from a blood vessel that enters the spinal cord at T6-T10 levels (it varies from patient to patient). Called the artery of Adamkievicz, this artery provides the blood flow for the gray matter of the thoracic spinal cord.

    Ischemia of the thoracic spinal cord may result if the artery is blocked as a result of damage to the aorta (in an automobile accident), an embolus (clot or collagen) goes into the artery, or inflammation of the artery. A unknown proportion of so-called transverse myelitis (TM) cases are likely to be due to ischemia of the spinal cord.

    Wise.

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    Super Moderator Sue Pendleton's Avatar
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    Originally posted by Wise Young:

    walkanotherday,

    There is no blood test that I know that would be able to distinguish between a stroke, TM, or other causes of injury to the spinal cord.
    _
    No, but once they decide it's a stroke in comes the blood guru from Georgetown with his own sticker to see if you have sticky platelets or a zillion things no one can pronounce. I mean she took 9 or 10 vials out of me and that took 4 sticks. I have beautiful blood was the basic result of all those tests.

    "A unknown proportion of so-called transverse myelitis (TM) cases are likely to be due to ischemia of the spinal cord."

    Or as one of my docs said..."the infarct could have caused TM or TM could have caused your infarct. (I think there was more than coffee in that cup.)

    Wise.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

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    I don't know... I became paraplegic as a result of embolizations. I lost sensations in my right leg after the first one. A few hours later, the doctor performed another embolization, and I lost the left leg too...and then the avm was still there compressing my spinal cord, so two weeks later, I lost anal sensations. If I had known then what I know now, I would have had the surgery done right there and then. The motor functions I have recovered happened after the avm was removed. As my surgeon put it,"in the hands of an experienced surgeon, it is a low-risk procedure" ((((

    gretchen 1

  10. #10
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    I had my AVM (Intraspinal Th4-Th8) fixed two years after my first symptoms witch where reduced sensation and motor starting slowly down in my legs. The problems continues and I lost more sensation/motor further up the legs...

    The AVM was discovered on MRI and following Arteriographi. I lives in Norway and here at the National Hospital several attempts with embolization was carried out, just one big "feeder" was glued - the minor "feeders" was considered to risky to navigate into with the catheter. I also went to a hospital in Paris (France) for second hand attempts with embolization without any luck...

    Finally surgery was considered the best option due to the AVM continued to grow/expand. A professor here in Norway arranged surgery in Phoenix AZ by Robert F. Spetzler at Barrows Neurological Institute. - He and his team managed to totally remove the AVM by surgery.

    Did I get any better after the surgery? Just minor improvements. But most important in my case, the surgery did stop the AVM to expand and causing furthermore problems for me. I know the surgery was risky, but did I have any other options?

    So in my case the answer is - I was not able to walk without any assistance after fixing the AVM. As for now I can walk some yards with crutches.

    I have also read that the window of opportunity after damage to the spinal cord due to an AVM is up to half a year, meaning functions lost in this window are likely to restore themselves. Above that I have also read that AVM damage to the spinal cord can be seen as a SCI and in general improvement window after surgery can be up to two years. Off course this is just in general.

    I have also some leg pain, for that I take Neurontin 3x600mg/day.

    So what next! Research and waiting for Stem-cell therapies.

    Leif



    Originally posted by walkanotherday:

    Last night's episode of House was about a paraplegic of two years who was cured after another health problem lead doctors to the discover the misdiagnosis of his SCI. It turned out his SCI was caused by some sort of vascular or AVM problem.

    The patient had so much swelling during the initial onset that the AVM was hidden from all the tests and MRI. It was only because of the anti-inflammatory effect of the steroids he was given for the other health problem that they were able to find the AVM.

    I know it's just a TV show and I'm obviously not a doctor but wouldn't there be clues in the bloodwork to show signs of stroke or any other vascular causes of SCI?

    Would fixing the AVM 2 years post-injury help a paraplegic walk?

    I'm curious becuase I'm a T8 of 3 years post and still am not sure exactly what happened to me. The Doctors suspect some sort of ischemic event.

    "My legs hurt like hell sometimes but if I don't think about it, it goes away."

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