Anterior spinal artery syndrome

A neurological condition caused by ischemia of the anterior spinal artery

Anterior spinal artery syndrome is a condition resulting from the interruption of blood supply to the anterior portion of the spinal cord. This syndrome is characterized by a range of neurological deficits due to ischemia in the territory supplied by the anterior spinal artery.

Anatomy and Pathophysiology

The anterior spinal artery is a critical vessel that supplies the anterior two-thirds of the spinal cord. It originates from the vertebral arteries and runs along the anterior median fissure of the spinal cord. The artery provides blood to the anterior horn, the anterior and lateral columns, and the central part of the spinal cord.

When the anterior spinal artery is compromised, the resulting ischemia affects the structures it supplies. This leads to a loss of function in the affected areas, primarily impacting the motor pathways and the spinothalamic tract, which carries pain and temperature sensations.

Clinical Presentation

Patients with anterior spinal artery syndrome typically present with sudden onset of symptoms, which may include:

• Paraplegia or quadriplegia, depending on the level of the spinal cord affected.
• Loss of pain and temperature sensation below the level of the lesion, due to involvement of the spinothalamic tract.
• Preservation of proprioception and vibratory sense, as these modalities are carried by the dorsal columns, which are supplied by the posterior spinal arteries.

Causes

The most common causes of anterior spinal artery syndrome include:

• Atherosclerosis leading to occlusion of the artery.
• Aortic dissection or aneurysm affecting the blood flow to the spinal artery.
• Trauma or surgical procedures that compromise the blood supply.
• Embolism or thrombosis.

Diagnosis

Diagnosis of anterior spinal artery syndrome is primarily clinical, supported by imaging studies. Magnetic resonance imaging (MRI) of the spine can reveal ischemic changes in the anterior portion of the spinal cord. Angiography may be used to visualize the blood supply and identify any occlusions or abnormalities in the anterior spinal artery.

Treatment

Management of anterior spinal artery syndrome focuses on addressing the underlying cause and providing supportive care. Treatment options may include:

• Anticoagulation therapy if an embolic or thrombotic event is suspected.
• Surgical intervention in cases of aortic dissection or aneurysm.
• Rehabilitation and physical therapy to maximize functional recovery.

Prognosis

The prognosis for patients with anterior spinal artery syndrome varies depending on the extent of the ischemic damage and the timeliness of treatment. Early intervention and rehabilitation can improve outcomes, but some patients may experience permanent neurological deficits.

Related Pages

• Spinal cord injury
• Ischemic myelopathy
• Vascular disease

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  Anterior spinal artery syndrome