Spinal Stroke

The spinal cord is an essential part of our central nervous system. The central nervous system consists of the brain and spinal cord. If we compare our body to a boat, then the brain and the spinal cord are the Captain and 1^st Officer respectively.

The spinal cord controls almost every part of your body: your skeletal muscles, internal organs, and it passes sensations from the rest of the body to the brain. It basically serves as the body’s “main road” for transportation.

If we think of the body as a computer, the parts of the computer need to communicate with each other in order to function. The spinal cord serves as the road that various chemicals, molecules and electrical signals can travel through. Just as a computer needs electricity and a car needs fuel, the spinal cord needs its own “fuel” as well. And the “fuel” for the spinal cord is nutrients and oxygen, which are supplied by blood.

What is a spinal stroke?

A spinal stroke is the disruption of the blood flow to supply nutrients and oxygen to the spinal cord. Without this “fuel”, cells of the spinal cord will be damaged and messages/information can no longer be transported from one part of the body to the other.

The spinal cord is surrounded by a complex network of blood vessels, but the two main ones are the anterior spinal artery (at the front of the spinal cord) and the posterior spinal artery (at the back). Spinal strokes in the anterior spinal artery are more common.¹ 

(Image taken from researchgate.net: https://www.researchgate.net/figure/The-Cervical-Spinal-Cord-and-Origin-of-the-Anterior-Spinal-Artery-The-anterior-spinal_fig2_311975365)

Spinal stroke can be divided into two large categories, depending on the cause of blood flow disruption:

1. If the disruption is caused by a blockage, the stroke is called ischaemic spinal stroke.
2. If the disruption is caused by bleeds, the stroke is called hemorrhagic spinal stroke.²

Symptoms of a spinal stroke

The symptoms of a spinal stroke depend on where on the spinal cord the blood supply is disrupted and how severe the lesion is. A common factor for most of the cases is that the symptoms occur suddenly, varying from minutes to hours after the stroke occurs.

Symptoms can include ^2-3:

• Sudden sharp and severe neck or back pain
• Sensation of constriction around the torso (this is usually the area where the blood supply to the spinal cord has been disrupted)
• Inability to control the bowels and/or the bladder (incontinence or the need to go the toilet with increased urgency)
• Loss of pain and/or temperature sensations
• Numbness or tingling sensations
• Muscle weakness in the legs
• In severe cases, a complete loss of movement (paralysis)

It is important to distinguish a  spinal stroke from a brain stroke. Patients with brain strokes often show the following symptoms which are not seen in a spinal stroke²:

• Difficulties speaking
• Vision problems
• Confusion and dizziness
• A sudden headache

Spinal stroke diagnosis

A doctor will perform a thorough examination and carry out tests to diagnose the cause of your symptoms. Symptoms such as weak muscle and loss of sensations may indicate a problem with the spinal cord. The next task is to determine the exact problem with the spinal cord, as many other conditions that lead to extra pressure on the spinal cord may present with similar symptoms (such as a slipped disc, an abscess, inflammation)¹.

Methods of diagnosing a spinal stroke ^1,4:

•  X-rays: An x-ray can reveal spinal column problems, allowing doctors to see if there are tumours, fractures or abnormal changes in the spine. This test is usually carried out in patients who are suspected of having a spinal cord injury after trauma.
• CT (Computerised Tomography) scan: A CT scan provides more details, allowing doctors to see if your symptoms are caused by disc issues or tumours.
• MRI (Magnetic Resonance Imaging) scan: MRI produces very detailed pictures and is very helpful for identifying herniated disks, blood clots or other masses that may pose pressure on the spinal cord. MRI is the key test for spinal stroke diagnosis.

Causes of spinal strokes

As mentioned before, spinal stroke occurs because the blood supply to the spinal cord is disrupted, either due to a blockage or a bleed.

The cause of a blockage of blood flow is usually due to the narrowing and hardening of the blood vessel. The arteries typically narrow and weaken as we age. However, people with the following conditions are at a higher risk of having weakened blood vessels and a therefore a spinal stroke²:

• High blood pressure/hypertension
• High blood cholesterol level
• Heart disease
• Obesity
• Diabetes
• Smoking
• High alcohol consumption

In other cases, the blockage of blood flow is due to a clinical condition called atherosclerosis. People with atherosclerosis also have narrow and hard/inelastic arteries. This is because there are fat deposits that have accumulated beneath the blood vessel wall. Ultimately, these fat deposits turn into clots.

As blood flows through the vessel, sometimes these clots will break off  the arterial wall and circulate around the body with the blood. If the clot flows to an artery which is not wide enough it will get stuck and block the artery, causing disruption in blood flow and delivery of nutrients to organs. When this happens as the artery is supplying to the spinal cord, an (ischaemic) spinal stroke occurs.

In addition to the blockage of blood flow, a small number of spinal strokes (hemorrhagic) are caused by the bursting and bleeding of one of the blood vessels supplying to the spinal cord. In this case, the most common cause is high blood pressure which damages and weakens the arteries, making them more likely to tear.

A less common cause is a burst of an aneurysm (balloon-like swelling in the arteries)¹. Usually, a haemorrhagic spinal stroke (blood vessel burst) is more serious and dangerous than an ischaemic spinal stroke (blockage to blood vessels), because in the former, blood continuously leaks out of the vessel and builds up in the surrounding tissues.

Treatments for spinal strokes

Spinal stroke can have different causes, so the treatment always depends on your symptoms and causes. Both your symptoms and their underlying cause need to be treated:

• For blood clots, medications working as antiplatelet (reduce the stickiness of platelets) and anticoagulants (interrupt the chemical process for blood clot formation) drugs, such as aspirin and warfarin, will be prescribed to reduce clot formation.
• For high blood pressure, you may be prescribed a medication that lowers your blood pressure, such as a statin.
• You may require additional physical/occupational therapy to preserve the function of your muscles if you are paralyzed or lost sensation ^1,2
• In the case of a hemorrhagic spinal stroke, emergency surgery may be needed to repair any burst blood vessels and remove the accumulated blood outside the vessel.⁵

Long-term effects of a spinal stroke

Spinal strokes can have long-term complications depending on the severity and location of the lesion.

Complications of a spinal stroke can include:

• Mobility problems and paralysis
• Bowel and bladder problems
• Problems with intercourse
• Muscle, joint, or nerve pain
• Mental health problems, such as anxiety and depression

Emergency treatment of the spinal stroke does not mark the full recovery. Its long-term effects may require specialist services of physiotherapists, occupational therapists, continence specialists and counsellors.

To help prevent strokes in the future, the best way is to address the underlying causes. Making changes to your lifestyle, doing regular exercises, quitting drinking alcohol and smoking, and eating a healthier (low sugar, low fat) diet. These are all the things we can do to prevent strokes.

People Also Ask

•  Can a stroke cause spinal cord injury?

A spinal stroke is caused by disrupted blood supply to the spinal cord. When blood supply is cut off, nutrients and oxygen can no longer be supplied to spinal cord cells, leading to cell death and tissue damage. Therefore, a stroke will lead to spinal cord injury.

• Is a spinal infarct a stroke?

Yes, spinal infarct is a stroke, a stroke caused by disrupted blood supply to the spinal cord.

The following is a definition of spinal infarct, or spinal cord infarction (SCI), given by the American Heart Association:

“Spinal cord cell death attributable to ischemia, based on pathological, imaging, or other objective evidence of spinal cord focal ischaemic injury in a defined vascular distribution.”⁶

• How rare is a spinal stroke?

Spinal strokes are a rare condition and are less common than brain strokes. They account for 0.3-1% of all strokes.⁷

• Can you recover from a spinal cord stroke?

This depends on the severity, the cause and the location of your stroke. Moreover, getting treatment quickly for stroke is a key determinant in prognosis. Immediate and proper emergency treatment can largely reduce long-term and prognostic complications.

• Does spinal cord injury affect the brain?

Yes. The spinal cord extends from the brainstem and spinal cord injury will lead to inflammation, which may affect the whole nervous system, including the brain.¹⁰

•  How many types of strokes are there?

There are 3 main types of strokes¹¹:

1. Ischaemic stroke: Caused by the blockage of blood flow to a region of the brain/spinal cord and it is the most common type of spinal stroke.
2. Hemorrhagic stroke: This is due to the bursting and bleeding of a weakened blood vessel supplying the brain/spinal cord.
3. Transient ischaemic attack (TIA): This is like a “mini stroke” caused by a temporary blockage in the blood flow. Symptoms usually last for just a few minutes or may go away in 24 hours.¹²