Blood Supply And Spinal Strokes: Understanding The Link

Spinal strokes are rare but dangerous and life-threatening. They occur when the blood supply to the spinal cord is disrupted, causing damage to the spinal tissues and cells. This disruption can be caused by a blockage, usually a blood clot, or a bleed. Without a steady blood supply, the spinal cord cannot receive the oxygen and nutrients it needs to function, leading to severe back pain, limb weakness, and loss of nerve sensation. In severe cases, a spinal stroke can result in paralysis or even death.

What is a spinal stroke?

A spinal stroke, also known as a spinal cord stroke or spinal cord infarction, is a disruption in the blood supply to the spinal cord. The spinal cord, which is part of the central nervous system, relies on a steady supply of blood to function properly. Spinal strokes occur when blood flow to the spine is blocked or cut off, preventing the spinal cord from getting the oxygen and nutrients it needs to function. This can lead to severe back pain, limb weakness, and loss of nerve sensation.

The blood supply to the spinal cord involves a complex system of blood vessels, with the main blood vessels being the anterior spinal artery at the front of the spinal cord and the posterior spinal artery at the back. Spinal strokes are most common in the anterior spinal artery.

Most spinal strokes are caused by blockages, typically blood clots, in the blood supply. These are called ischaemic spinal strokes. However, some spinal strokes are caused by bleeds, known as haemorrhagic spinal strokes. Spinal strokes are rare, accounting for only about 1% of all strokes, and they can be life-threatening.

The symptoms of a spinal stroke depend on which section of the spinal cord is affected and the extent of the damage. Common symptoms include sudden and severe neck or back pain, muscle weakness in the legs, problems with the bowel and bladder, and changes in sensation in the lower half of the body. These symptoms can progress quickly and may lead to paralysis if not treated promptly.

The underlying causes of spinal strokes are often related to changes in the shape and function of blood vessels. Factors such as high blood pressure, high cholesterol, heart disease, diabetes, smoking, excessive alcohol consumption, and lack of exercise can increase the risk of spinal strokes by affecting the health and structure of blood vessels.

Treatment for spinal strokes focuses on addressing the underlying cause and managing symptoms. Medications may be prescribed to thin the blood, reduce blood clots, and control risk factors such as high blood pressure or high cholesterol. In some cases, surgery may be required to remove blood clots or address other underlying conditions. Physical and occupational therapy may also be beneficial for individuals experiencing paralysis or loss of sensation.

What are the symptoms?

Spinal strokes are rare, accounting for only around 1% of all strokes. They occur when the blood supply to the spinal cord is disrupted, causing tissue damage and impairing spinal cord function. The symptoms of a spinal stroke depend on which part of the spinal cord is affected and the extent of the damage.

Symptoms of a spinal stroke typically appear suddenly and tend to worsen over time. In most cases, the first symptom is sudden and severe neck or back pain. Other common symptoms include:

• Muscle weakness in the legs, which can progress to a complete loss of movement (paralysis)
• Problems controlling the bowel and bladder (incontinence)
• Unusual sensations in the lower half of the body, such as numbness, burning, or tingling sensations
• Loss of sensation of temperature
• Tightness or pain in the chest
• Difficulty breathing

If you or someone you know is experiencing these symptoms, seek immediate medical attention. Spinal strokes can be life-threatening and may lead to permanent paralysis or other serious health issues if left untreated.

What causes it?

Spinal strokes are caused by a disruption in the blood supply to the spinal cord, which can be due to a blockage or a bleed. Spinal strokes are rare, accounting for only 0.3-1.25% of all strokes.

Most spinal strokes are ischemic, meaning they are caused by blood clots in the blood vessels that supply blood to the spinal cord. This is often due to a thickening or narrowing of the arteries, known as atherosclerosis or arteriosclerosis, which can be caused by a buildup of plaque or fatty deposits. People with certain health conditions and lifestyle habits are more prone to atherosclerosis, including those with high blood pressure, high cholesterol, heart disease, diabetes, obesity, smoking, excessive alcohol consumption, and lack of physical exercise.

A smaller percentage of spinal strokes are hemorrhagic, meaning they are caused by a bleed in the blood vessels supplying the spinal cord. This is typically due to high blood pressure or a burst aneurysm, which is a balloon-like swelling in the artery. Other causes of hemorrhagic spinal strokes include tangled blood vessels, known as arteriovenous malformations, and benign blood vessel tumours called haemangiomas.

Less common causes of spinal strokes include abdominal surgery, cancer, decompression sickness, nerve damage, spinal compression, cauda equina syndrome, and secondary spinal tumours.

How is it diagnosed?

Spinal strokes are challenging to diagnose because the initial symptoms can be indicative of several other conditions. At the hospital, a doctor will ask about your medical history and perform a physical exam to rule out other conditions that could be causing pressure on the spinal cord, such as a slipped disc, tumour, or abscess.

If a spinal cord problem is suspected, a doctor will likely order a magnetic resonance imaging (MRI) scan. An MRI scan produces highly detailed images of the spine using strong magnetic fields and radio waves. The MRI scan can help confirm the presence and location of a blockage or bleed in the spinal cord. However, it is important to note that in some cases, spinal strokes may not show up on MRI images, leading to delayed diagnoses.

If a spinal stroke is diagnosed, treatment will depend on the underlying cause. For ischaemic spinal strokes caused by blood clots, medications such as antiplatelet and anticoagulant drugs may be prescribed to thin the blood and reduce the risk of blood clots. For haemorrhagic spinal strokes caused by bleeding, the treatment will focus on controlling high blood pressure or addressing aneurysms.

What are the treatment options?

Spinal strokes are rare, accounting for just 0.3% to 1.25% of all strokes. They are caused by a disruption in the blood supply to the spinal cord, which can cause injury or damage to tissues and block messages (nerve impulses) travelling along the spinal cord. The majority of spinal strokes are ischemic, meaning they are caused by blood clots in blood vessels. A smaller number of spinal strokes are haemorrhagic, caused by bleeding from ruptured blood vessels.

Treatment for a spinal stroke will depend on the underlying cause. Here are some of the treatment options:

Ischemic Spinal Stroke

If the spinal stroke is ischemic, meaning it is caused by a blood clot, medication will be given to thin the blood and reduce the risk of blood clots. These are known as antiplatelet and anticoagulant drugs, such as heparin, warfarin, or aspirin.

Haemorrhagic Spinal Stroke

If the spinal stroke is haemorrhagic, caused by bleeding from ruptured blood vessels, the treatment will focus on stopping the bleeding and repairing any damage caused. In this case, medication may be given to normalise blood pressure and control cholesterol levels.

Tumours

If the spinal stroke is caused by a tumour, corticosteroids will be used to reduce the swelling, and the tumour will be removed surgically.

Paralysis

If paralysis or loss of sensation occurs, physical and occupational therapy may help to regain some range of motion and preserve muscle function.

Bladder Incontinence

If bladder control is lost, a urinary catheter may be necessary.

Lifestyle Changes

Regardless of the type of spinal stroke, certain lifestyle changes can help to improve the chances of recovery. These include adopting a healthy, balanced diet, exercising regularly, maintaining a moderate weight, and reducing alcohol consumption.

Frequently asked questions