In contrast to a complete spinal cord injury, lesions only affect part of the cord and patients present with a dissociated sensory loss. We present a case of anterior spinal artery syndrome in a 57yearold man having a total hip arthroplasty under epidural anaesthesia. Jun 06, 2018 anterior spinal artery syndrome anterior cord syndrome. Anterior spinal artery radiology reference article.
It arises from branches of the vertebral arteries and courses along the anterior aspect of the spinal cord. Med any combination of signs and symptoms that are indicative of a particular disease or disorder syndrome, mr. The blood supply to the anterior part of the spinal cord, through the artery of adamkiewicz, may be impaired intraoperatively leading to neurological sequelae known as the anterior spinal artery syndrome, characterised by loss of motor function with intact or partially intact sensory function. When the cervical spine is involved, breathing disorders may be observed. We report a case of anterior spinal artery syndrome in which immediate and 3year follow. Figure 3 onethird of cases will present with radiating pain which is an important clinical clue for sci. After the operative repair with precautions taken to avoid further neurological in jury, the neurological deficit resolved partially. The patient has been followed up for yr since this event in 1977. Spinal artery, anterior article about spinal artery. A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of the spinal cord. Anterior spinal artery syndrome complicated by the ondine.
Anterior spinal artery syndrome asas is often a devastating spinal stroke occurring when the anterior spinal artery or one of its supplying anterior medullary arteries are occluded. The rhythmic beating of the heart is a ceaseless activity, lasting from before birth to the end of life. Posterior spinal artery an overview sciencedirect topics. Anterior spinal artery syndrome the most common clinical presentation of a spinal cord infarction is anterior spinal artery asa syndrome 1,6,10. Treatments for anterior spinal artery syndrome including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. Anterior spinal artery syndrome commonest of the vascular syndromes of the cord. It follows facial paralysis and seems to be due to straying of the regenerating nerve fibers, some of those destined for the salivary glands going to the lacrimal glands. Maninthebarrel syndrome typical of watershed infarcts between anteriormiddle cerebral artery territories has also been reported with other bilateral cerebral pathology metastases, hemorrhagic contusions, or multiple sclerosis, pontine damage central pontine myelinolysis, odontoid fracture, or ischemia, cervical cord injury anterior. The diagnosis usually is made on the basis of clinical findings because the cause of the syndrome remains obscure in most cases 2.
Anterior spinal artery thrombosis following trivial trauma in a. Anterior spinal artery syndrome with chronic traumatic. The two vertebral arteries one of which is usually bigger than the other anastamose in the midline to form a single anterior spinal artery at the level of the foramen magnum. The blood supply to the anterior part of the spinal cord, through the artery of adamkiewicz.
Apr 01, 2012 anterior spinal cord syndrome comprises ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral twothirds of the spinal cord. Background anterior spinal artery asa syndrome results in motor palsy and dissociated sensory loss below the level of the lesion, accompanied by bladder dysfunction. The anterior spinal cord is at increased risk for infarction because it is supplied by the single anterior spinal artery, which has few collateral unlike the posterior spinal cord which is supplied by two posterior spinal arteries. Anterior spinal artery syndrome anterior spinal artery syndrome djurberg, h. A opacification of t8 and t9 intercostal ar teries on a delayed angiogram after selective injection of the ti0 intercostal artery no longer filled. Anterior spinal artery syndrome a complication of cervical. Anterior spinal artery syndrome also known as anterior spinal cord syndrome is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior twothirds of the spinal cord. We report a case of anterior spinal artery syndrome in which the patient had severe stenosis of a vertebral artery, occlusion of. The anterior spinal artery syndrome was first described by spiller 1 in a case of thrombosis of this artery. Incomplete spinal cord syndromes are caused by lesions of the ascending or descending spinal tracts that result from trauma, spinal compression, or occlusion of spinal arteries. The diagnosis usually is made on the basis of clinical. Anterior spinal artery syndrome during the postpartum. Ventral cord syndrome also known as anterior cord syndrome is one of the incomplete cord syndromes and affects the anterior parts of the cord resulting in a pattern of neurological dysfunction dominated by motor paralysis and loss of pain, temperature and autonomic function. The region affected includes the descending corticospinal tract, ascending spinothalamic tract, and autonomic fibers.
Anterior spinal artery syndrome in a patient with cervical. Spinal cord infarction because of spontaneous vertebral. Anterior spinal artery syndrome presenting as cervical. While initially linked to infections, in particular syphilis, many. Anterior spinal artery syndrome wiley online library. Anterior spinal artery syndrome online medical video lecturio. This syndrome was first described by spiller in 1909. Summary of the clinical features of spinal cord infarction. Anterior spinal artery syndrome asas or spillers syndrome is named for william g. It is characterized by a corresponding loss of motor function, loss of pain and temperature sensation, and hypotension. Anterior spinal artery syndrome anterior spinal artery syndrome djurberg, h haddad, m. Anterior spinal artery syndrome after epidural anesthesia.
The spinal cord receives blood supply from two posterior arteries 25% and one anterior spinal artery 75%. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Pdf thrombolysis in anterior spinal artery syndrome. Anterior spinal artery syndrome associated with severe. The etiology is varied ranging from atherosclerosis, vasculitis. The anterior spinal artery of adamkiewicz which supplies this region of the spinal cord is susceptible to occlusion in the midlumbar region as the radicular artery supplying it is an end artery.
The anterior artery supplies the motor tracts and is formed by the fusion vertebral arteries and receives reinforcement of blood supply from 6 to 8 radicular arteries, the artery of adamkiewicz is the most important of these. Treatment is determined based on the primary cause of anterior cord syndrome. Three patients with symptoms due to the anterior spinal artery syndrome were treated by direct perfusion of dexamethasone sodium phosphate and urokinase. Anterior spinal artery synonyms, anterior spinal artery pronunciation, anterior spinal artery translation, english dictionary definition of anterior spinal artery. The most common causes are arteriosclerosis, dissection of the. Objective to describe the polysomnographic findings in a patient with cervical asa syndrome complicated by a sleep breathing disorder. It is reinforced by several contributory arteries, especially the artery of adamkiewicz. The blood supply to the anterior part of the spinal cord, through the artery of adamkiewicz, may be impaired intra. Anterior spinal artery definition of anterior spinal. Anterior spinal artery syndrome is the most common form of spinal cord infarction. Anterior spinal artery syndrome is syndrome caused by ischemia of the anterior spinal artery. It is caused by occlusion or hypoperfusion of the anterior spinal artery asa, which supplies the anterior two. Be cause of the potential for symptomatic spinal cord ischemia resulting from lesions of the aorta, angio graphic delineation of the spinal cord blood supply.
Anterior cordanterior spinal artery syndrome youtube. Haddad, md, frcr, senior consultant radiologist in charge of teaching, departments of anaesthesia and radiology, armed forces hospital, p. Thank you for the opportunity of replying to d r williams letter. Anterior spinal cord syndrome comprises ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral twothirds of the spinal cord. Anterior spinal artery syndrome asas is an extremely rare cause of acute ischemic cord infarction, which usually presents as an acute and painful myelopathy. The anterior spinal artery syndrome was first described by spiller. Anterior spinal artery syndrome or becks syndrome or anterior cord syndrome is a rare neurovascular condition characterized by sudden ischemia with damage to the anterior 23rd of the spinal cord. The anterior spinal artery syndrome is the most common presentation of sci as illustrated in our patient. The onset of signs and symptoms is abrupt, and the functional losses correspond to the territory of distribution that the artery supplies i. Eastwood, university hospitals of cleveland, 2074 abington road, cleveland, oh 44106.
The anterior spinal artery syndrome asas, described by preobraschenski in 1908,1 is characterized by bilateral spastic paraparesis and dissociated sensory deficits involving bilateral loss of temperature and pain sensation but preserved proprioception and touch. Syndrome pop culture when innocent heroworship goes unrequited, the consequences can be dire for both the admirer and the admired. Anterior spinal artery syndrome udiya ak, shetty gs. Find out information about spinal artery, anterior. Spiller who described it 1909, however preobranshenski was the first to describe asas in 1904. After 10 days of treatment, flicker of contractions was noted in the lower limbs.
Anterior spinal artery syndrome article about anterior. You can manage this and all other alerts in my account. The anterior spinal artery syndrome occurs as a result of the occlusion of the anterior spinal artery itself or of the arteries that reinforce it see chapter 3. Occurs due to aortic dissection, atherosclerosis of aorta, sle, aids, av malformation rarely due to dissection of the anterior spinal artery or systemic arteritis. Anterior spinal artery syndrome is a rare presentation of acute spinal cord infarction. You will receive an email whenever this article is corrected, updated, or cited in the literature. Anterior spinal artery syndrome anterior cord syndrome. For specific syndromes, see under the name, such as adrenogenital syndrome or reyes syndrome. This leaves multiple areas of the cord vulnerable to watershed. The motor neurones of the spinal cord are supplied by the anterior spinal artery and its sulcocommissural arteries fig.
Anterior spinal cord syndrome involves complete motor paralysis and loss of temperature and pain perception distal to the lesion. In human anatomy, the anterior spinal artery is the artery that supplies the anterior portion of the spinal cord. Anterior spinal artery infarction causing maninthe. The typical patient at risk of anterior spinal artery syndrome is an elderly patient with a past history of arteriosclerosis or recent period of hypotension, who presents with a sudden onset of flaccid paralysis. Incredibles wannabe sidekick turned bad guy, from the incredibles 2004. Anterior spinal artery syndrome the free dictionary. Anterior spinal artery syndrome anterior spinal artery syndrome is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. The typical presentation of ascs is an acute and painful myelopathy. Please practice handwashing and social distancing, and. Anterior spinal artery ischemia is the most common cause. Anterior spinal artery syndrome during the postpartum period. A true acs results from a vascular lesion at the anterior spinal artery asa resulting in ischemic injury to the respective area of. Anterior spinal artery definition of anterior spinal artery.
Find out information about anterior spinal artery syndrome. Incomplete spinal cord syndromes knowledge for medical. Anterior spinal artery an overview sciencedirect topics. Spinal cord infarcts are rare, and the most recent publications were case reports describing clinical and radiological features, or unusual causes.
The posterior arteries supply the sensory tracts in the spinal cord and receive flow from posterior and inferior cerebellar arteries, the vertebral arteries. This syndrome manifests as a suspended pattern of total anesthesia at the affected level. A single anterior spinal artery arises from branches off both vertebral arteries to supply the anterior twothirds of the spinal cord. The most common causes are arteriosclerosis, dissection of the abdominal aorta, cardiac embolism and degenerative spine disease, and the major risk factors are smoking, hypertension, diabetes and. Since posterior columns are spared, light touch, vibration, and.
Common etiologies include mediastinal surgeries 1 2, diabetes with atherosclerosis 3, diseases of the aorta 4, hematological. Anterior spinal artery syndrome definition of anterior. The asas typically develops acutely, over minutes to hours. Anterior spinal artery syndrome is an extremely rare cause of acute ischemic. This is a report of a patient with diabetic scleredema in whom anterior spinal artery syndrome developed as a complication of an epidural anesthetic.
Treatment by intermittent positive pressure ventilation normalized the respiratory pattern and sleep architecture. Posterior spinal artery infarctions are less common than anterior infarctions, but they do occur. The cause of the infarction can be either iatrogenic or secondary to diseases. Anterior spinal artery syndrome asas is a very rare condition which occurs following infarction of the anterior twothird of the spinal cord supplied by the anterior spinal artery.
The anterior spinal artery supplies the anterior portion of the spinal cord and arises from the vertebral artery in the region of the medulla oblongata. We have seen a case of terminal malignant melanoma in which clinical manifestations, indicative of anterior spinal artery syndrome, developed following the injection of 0. Consistent with its functional neuroanatomy, an asa infarct typically presents as loss of motor function and paintemperature sensation, with relative sparing of proprioception and vibratory. The posterior arteries supply the sensory tracts in the spinal cord and receive flow from posterior and inferior cerebellar arteries, the vertebral arteries, and the posterior radicular arteries. Anterior spinal artery syndrome synonyms, anterior spinal artery syndrome pronunciation, anterior spinal artery syndrome translation, english dictionary definition of anterior spinal artery syndrome.
It is characterized by a corresponding loss of motor function. Anterior spinal artery syndrome is syndrome caused by ischemia of the anterior spinal artery, resulting in loss of function of the anterior twothirds of the spinal cord. The anterior spinal artery syndrome is an unusual cause of myelopathy during pregnancy and the postpartum period. Anterior spinal artery asa syndrome is a rare and devastating neurological. In 1938, barre and dandrade reported a case of anterior spinal artery infarction involving the fourth and fifth thoracic cord segments occurring during the seventh month of pregnancy 1 and confirmed at the time of necropsy. Central cord syndrome, anterior cord syndrome, posterior cord syndrome, and brownsequard syndrome are the most common types of incomplete spinal cord syndromes. Pdf anterior spinal artery syndrome associated with severe. This report describes the clinical course of the patient over a period of 4 months after. Ohmeda steeton fully agrees with dr williamss conclusions regarding routine inspection and cleaning of the switching mechanism for soda lime contamination. Pdf anterior spinal artery syndrome associated with. Asas is thrombosis ventral to the spinal cord causing blockage of the anterior spinal artery asa and an infarction of the areas supplied. Anterior spinal artery syndrome complicated by the ondine curse.
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