Spinal cord ischaemia presents with acute onset back pain, bilateral weakness and paresthesia. Loss of sphincter control and inability to void or defecate may develop later. Differential diagnoses include acute transverse myelopathy, myelitis, Guillain-Barré syndrome and mass lesions. However, these conditions usually develop with an acute but slower evolution than spinal cord infarction.
The aetiology for spinal cord ischaemia is the same as that for stroke. Atherosclerotic thromboembolic disease and primary haemorrhage are the most common causes, with aneurysms, AVMs and haemangiomas also responsible for a minority of cases.
The spinal cord is supplied by the anterior spinal artery and the paired posterior spinal arteries, which form anastomoses. The anterior spinal artery is formed at the foramen magnum by branches from the vertebral arteries and receives further segmental radicular arteries from the aorta along its length, with the largest radicular artery being the artery of Adamkiewicz.
Anterior cord syndrome is the most common presentation for spinal ischaemia, with posterior cord syndrome being very rare. Anterior cord syndrome is characterised by loss of motor function and loss of sensations carried by the anterior columns of the spinal cord (pain and temperature) below the level of injury with preservation of sensations carried by the posterior columns (fine touch, vibration and proprioception).