Abstract Details

Title Vascular Territories In Spinal Cord Strokes: Topographic Analysis In 61 Cases

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S33 - Cerebrovascular Disease: Basic Sciences and Cohort Studies (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Background Spinal cord strokes are underreported and often misdiagnosed as “transverse myelitis”.

Objective To characterize the topography and vascular territories in lesions produced by acute spinal cord strokes.

Design/Methods Sixty-one patients with spinal cord strokes seen between 2015 and May 2021 were analyzed at a specialized referral center. Lesion distribution on T2 weighted sagittal and axial MRI was identified and compared to previously established predictive vascular territories after a review of MRIs by 2 independent neurologists.

Results Out of 61 subjects with spinal cord strokes, most were female (n=36, 59%) and the median age at onset was 54 [IQR 38-61] years. On MRI, most lesions were monofocal (n=44, 72%), and presented as short length (51%). Stroke-lesions affected the cervical cord in 27 (44%), the thoracic cord in 43 (70%) and the lumbar cord-conus in 25 (41%) subjects. Most of the lesions involved the anterior (85%) and central (82%) compartments of the cord while 58% involved the posterior region. In the cervical cord, strokes involved the vertebral artery (VA) anterior spinal artery (ASA) territory in 26 (43%) subjects and the VA-posterior spinal artery (PSA) territory in 8 (13%). Only one subject had exclusive VA-PSA involvement. The ASA territory was compromised in the cervicothoracic region in 27 (45%) patients and in the thoracolumbar region (artery of Adamkiewicz’s territory) in 30 (50%) patients. Fifteen (25%) cases involved the posterior conus watershed territory. Six patients (10%) exhibited associated vertebral bone infarction. Classic imaging findings of spinal cord ischemia such as owl’s eyes and H sign were observed in 19 (32%) and 13 (22%) patients, respectively.

Conclusions Spinal cord strokes presented frequently in the thoracic cord segments and watershed areas. Bone infarctions, “owl's eyes” and H sign can support the diagnosis of vascular ischemic myelopathies but are not a common finding.

Authors/Disclosures
David Acero-Garces, MD (Johns Hopkins University) PRESENTER	The institution of Dr. Acero-Garces has received research support from Ministry of Science, Technology and Innovation of Colombia.
Paula Barreras, MD (Cedars-Sinai Medical Center)	The institution of Dr. Barreras has received research support from Foundation for Sarcoidosis Research. The institution of Dr. Barreras has received research support from American Academy of Neurology.
Susana Dominguez Penuela, MD (Johns Hopkins University School of Medicine)	Dr. Dominguez Penuela has nothing to disclose.
Carlos A. Pardo-Villamizar, MD (Johns Hopkins U, Med Dept of Neurology)	The institution of Dr. Pardo-Villamizar has received research support from National Institutes of Health. The institution of Dr. Pardo-Villamizar has received research support from Bart McLean Fund for Neuroimmunology Research .