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Thread: Question Dr Wise or anyone...

  1. #1

    Question Dr Wise or anyone...

    Dr. Wise:

    I have Anterior spinal cord ischemia caused by blood loss. The Neurologist said it affected C2-T2. I read that temperature and pain sensation “move through the grey matter” that is why they are lost with this type of injury. Does motor function also “move through the grey matter”? What about bowel and bladder function? What is the likely hood of regaining sensory loss in an injury such as this? Are there any good studies on recovery after such an injury?

    Thank you for your time.

  2. #2
    What is your actual level of injury (lowest level with normal sensation and a muscle grade of 3 or better)? With anterior spinal artery syndrome I would assume you have some pressure and position sense below the level of your injury?

    The anterior spinal artery supplies the front 2/3 of the cord, which includes most of the motor tracks (both axons and neurons) and pain and temperature and light touch tracks (which travel in the front part of the cord in the white matter).
    You might want to read Dr. Young's article here about spinal cord circulation.

    Here is a diagram of the major spinal cord tracts and their functions. The blue ones are sensory, while the red are motor. The top of the picture it toward the back of the cord, the bottom toward the front. The anterior spinal artery rests in the groove in the front of the cord (at the bottom of this diagram):



    (KLD)
    Last edited by SCI-Nurse; 08-01-2007 at 11:27 AM.

  3. #3
    No one has ever told me my actual level of injury, but I cannot feel pain of temperature below my collar bone, except for on my right arm. All my muscles are 4 or better (I walk very well unassisted). What does that make me? I can feel light touch and position 100%.

    Thank you for the information!

  4. #4
    Quote Originally Posted by luckydog
    No one has ever told me my actual level of injury, but I cannot feel pain of temperature below my collar bone, except for on my right arm. All my muscles are 4 or better (I walk very well unassisted). What does that make me? I can feel light touch and position 100%.

    Thank you for the information!
    Lucky, what you describe is not an anterior spinal cord syndrome. Give me a little time to post an article on this subject. The whole question of what ischemia damages in the spinal cord is a big subject and I want to get the best information out there instead of the dogmas that are in the textbooks, etc.

    Wise.

  5. #5
    I would be very grateful for the information. My Neurologist told me, I had an infarction from c2-t2 in the anterior cord caused from ischemia. The theory is that I had strep throat virus (not sure the technical term) in my blood which clogged up my spinal cord and then was broken up by the pressure and disappeared… they could find no point of infection. The did three MRIs and a variety of other test including looking behind my heart for an infection, but there was none. I am 16 weeks post stroke.

  6. #6
    ANTERIOR SPINAL ARTERY SYNDROME VS THE ANTERIOR CORD SYNDROME
    by Wise Young, PhD MD
    W. M. Keck Center for Collaborative Neuroscience, Rutgers University, Piscataway, NJ

    Let me begin by differentiating between the two conditions.
    • The anterior cord syndrome results from compression of the spinal cord from the front, causing loss of muscle strength with relative preservation of sensory function below the injury site.
    • The anterior spinal artery syndrome results from occlusion of the anterior spinal artery, damaging gray matter and anterior part of the spinal cord. It is often associated with flaccid paralysis and loss of pain and temperature sensations below the injury site.

    Anterior Spinal Artery Syndrome

    I wrote an article about the vascular and cerebrospinal fluid supply of the spinal cord in 2000 (Source). The following figure is a cut-away picture of the spinal cord showing the gray matter, the anterior spinal artery (to the right). When the anterior spinal artery is occluded, the gray matter in the spinal cord close to the occlusion site becomes ischemic (lacks blood flow) and may die.



    The reason why I say "may die" as opposed to "will die" is because blood flow in the anterior spinal artery provides blood to the entire length of the spinal cord. It receives blood from several radiculo-medullary arteries. In the human, the artery of Adamkiewicz is the main vascular supply for the anterior spinal artery in the thoracic spinal cord. This artery emanates from the aorta and enters the spinal column at about T6.

    Damage or occlusion to the artery of Adamkiewicz will reduce the pressure in the anterior spinal artery and cause ischemia throughout most of the thoracic and lumbar spinal cord. Because the basilar artery from above supplies the anterior spinal artery, the cervical spinal cord is less affected. Damage to this artery often happens in people who have been in traffic accidents that have injured their aorta and produced dissecting aneurisms of the aorta. After surgery, they become paralyzed below T4-T6.

    The basilar artery supplies the upper end of the anterior spinal artery in the cervical spinal cord. If the basilar artery is occluded (due to cervical compression, inflammation of the artery, etc.), the upper cervical spinal cord will become ischemic and may be damaged. The following is a picture of the basilar artery branching to become the two thick vertebral artery, and a very thin anterior spinal artery coming from the two vertebral arteries.



    When the anterior spinal artery is occluded in the cervical spinal cord, its effects tend to be segmental and the injury seldom causes "complete" loss of ascending motor and sensory function passing through the area. If it occurs in the C1-3 levels, it may affect the phrenic nucleus which controls breathing.

    The manifestions of the anterior spinal artery syndrome differ considerably depending on its level. If it occurs in the cervical spinal cord, it produces a condition that may be more like a central cord syndrome. However, when it occurs in the thoracic region, it often is associated with multisegmental gray matter loss in the thoracic and lumbar cord, resulting in flaccid paralysis of the legs.

    Anterior Cord Syndrome

    There are three special categories of "incomplete" spinal cord injury. One is called the central cord syndrome, a second one is called the posterior cord syndrome, and the third is an anterior cord syndrome. The central cord syndrome affects mostly the segment function in the cervical spine (e.g. weak shoulder, arms, and hands) but relatively intact leg function. The posterior cord syndrome is one where proprioceptive sensations are gone but motor function remains. The anterior cord syndrome is one where sensation is present but motor function is absent or very weak.

    In some ways, the anterior spinal artery syndrome produces a condition that is more like a central cord syndrome than an anterior cord syndrome. Note that the anterior, central, and posterior designation of the lesion may not be correct. For example, Dick Bunge at the Miami Project found in the mid-1990's that the central cord syndrome is more a result of lateral column damage than gray matter damage.

    In any case, despite the similar of their names, the anterior spinal artery syndrome does not produce the anterior cord syndrome. Many people and web sites make that mistake. For example, anterior cord syndrome is often equated to anterior spinal artery syndrome. (Source). That definition, unfortunately is perpetuated by a text book, the Wheeless' Textbook of Orthopedics (Source).

    The original definition of the anterior cord syndrome was first proposed by Dick Schneider, an orthopedic surgeon who also named the central cord syndrome. In 1951, Schneider presented two patients who had "immediate complete paralysis with hyperesthesia at the level of the lesion and an associated sparing of touch and some vibration sense." Both patients had ruptured discs or bone fragments in the spinal canal compressing the front of the spinal cord. Schneider recommended surgery (see attached). The prognosis for recovery of people with the anterior spinal syndrome is relatively good, particularly if decompression of the cord is carried out early.

    Last edited by Wise Young; 08-04-2007 at 04:06 PM.

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