A spinal stroke, also called a spinal cord stroke, occurs when the blood supply to the spinal cord is cut off. The spinal cord is part of the central nervous system (CNS), which also includes the brain. When the blood supply is cut off, the spinal cord can’t get oxygen and nutrients. The tissues of the spinal cord may be damaged and not be able to send nerve impulses (messages) to the rest of your body. These nerve impulses are vital for controlling activities of the body, such as moving the arms and legs, and allowing your organs to work properly.
The majority of spinal strokes are caused by a blockage in the blood vessels that supply blood to the spine, such as a blood clot. These are called ischemic spinal strokes. A small number of spinal strokes are caused by bleeds. These are called hemorrhagic spinal strokes.
A spinal stroke is different than a stroke that affects the brain. In a brain stroke, the blood supply to the brain is cut off. Spinal strokes are much less common than strokes that affect the brain, accounting for less than two percent of all strokes.
What are the symptoms of a spinal stroke?
The symptoms of a spinal stroke depend on what part of the spinal cord is affected and how much damage is done to the spinal cord.
In most cases, symptoms will appear suddenly, but they may come on hours after the stroke occurs. Symptoms include:
- sudden and severe neck or back pain
- muscle weakness in the legs
- problems controlling the bowel and bladder (incontinence)
- feeling like there is a tight band around the torso
- muscle spasms
- tingling sensations
- inability to feel heat or cold
This is different from a brain stroke, which also results in:
- difficulty speaking
- vision problems
- a sudden headache
What causes a spinal stroke?
A spinal stroke is caused by a disruption in the blood supply to the spine. Most of the time, this is a result of a narrowing of the arteries (blood vessels) that supply blood to the spinal cord. Narrowing of the arteries is called atherosclerosis. Atherosclerosis is caused by a buildup of plaque.
The arteries typically narrow and weaken as we age. However, people with the following conditions are at a higher risk of having narrow or weakened arteries:
A spinal stroke can be triggered when a blood clot blocks off one of the arteries supplying the spinal cord. A blood clot can form anywhere in the body and travel in the bloodstream until it gets stuck in an artery that has been narrowed due to plaque. This is referred to as an ischemic stroke.
A smaller percentage of spinal strokes occur when one of the blood vessels supplying the spinal cord bursts open and starts bleeding. The cause of this type of spinal stroke, also called a hemorrhagic stroke, is high blood pressure or an aneurysm that bursts. An aneurysm is a bulge in the wall of the artery.
Less commonly, a spinal stroke may be a complication of the following conditions:
- tumors, including spinal chordomas
- vascular malformations of the spine
- injury, such as a gunshot wound
- spinal tuberculosis or other infections around the spine, like an abscess
- spinal cord compression
- cauda equine syndrome (CES)
- abdominal or heart surgery
Spinal stroke in children
A spinal stroke in a child is exceedingly rare. The cause of a spinal stroke in children is different from those in adults. Most of the time, a spinal stroke in a child is caused by either an injury to the spine, or a congenital condition that causes problems with the blood vessels or affects blood clotting. Congenital conditions that may cause spinal strokes in children include:
- cavernous malformations, a condition that causes small clusters of abnormal, enlarged blood vessels that periodically bleed
- arteriovenous malformations, an abnormal tangle of vessels in the brain or spinal cord
- moyamoya disease, a rare condition where certain arteries at the base of the brain are constricted
- vasculitis (inflammation of the blood vessels)
- clotting disorders
- lack of vitamin K
- infections, such as bacterial meningitis
- sickle cell anemia
- umbilical artery catheter in a newborn
- a complication of heart surgery
In some cases, the cause of the spinal stroke in a child is unknown.
Diagnosing a spinal stroke
At the hospital, a doctor will ask about your medical history and perform a physical exam. Based on your symptoms, your doctor will likely suspect a problem with the spinal cord. They may want to rule out other conditions that could be putting pressure on the spinal cord, like a slipped disc, tumor, or an abscess.
To diagnose a spinal stroke, your doctor will likely take a magnetic resonance imaging scan, commonly referred to as an MRI. This type of scan creates images of the spine that are more detailed than an X-ray.
How is a spinal stroke treated?
Treatment is aimed at treating the cause of the spinal stroke and reducing symptoms, for example:
- To treat a blood clot, you may be prescribed medications known as antiplatelet and anticoagulant drugs, such as aspirin and warfarin (Coumadin). These drugs reduce the chance of another clot forming.
- For high blood pressure, you may be prescribed a medication that lowers your blood pressure.
- For high cholesterol you may be prescribed a medication to lower your blood pressure, such as a statin.
- If you become paralyzed or lose sensation in certain parts of your body, you may require physical and occupational therapy to preserve the function of your muscles.
- If you have bladder incontinence, you may need to use a urinary catheter.
- If the spinal stroke was caused by a tumor, corticosteroids are used to reduce the swelling. The tumor will be removed surgically.
If you smoke, you will likely be asked to quit. To improve your blood pressure and cholesterol levels, you should also eat a balanced and healthy diet rich in fruits, vegetables, and whole grains.
Complications of a spinal stroke
Complications depend on which part of the spine is affected. For example, if the blood supply to the front of the spinal cord is reduced, your legs can be permanently paralyzed.
Other complications include:
- breathing difficulties
- permanent paralysis
- bowel and bladder incontinence
- sexual dysfunction
- muscle, joint, or nerve pain
- pressure sores due to loss of sensation in certain parts of the body
- muscle tone problems, such as spasticity (uncontrolled tightening in the muscles) or lack of muscle tone (flaccidity)
Recovery and outlook
The recovery and overall outlook depends on how much of the spinal cord is affected and your overall health, but it’s possible to make a full recovery over time. Many people won’t be able to walk for a while after a spinal stroke and will need to use a urinary catheter.
In one study of people who had a spinal stroke, 40 percent were able to walk on their own after the mean follow-up time of 4.5 years, 30 percent could walk with a walking aid, and 20 percent were wheelchair-bound. Similarly, about 40 percent of people regained normal function of their bladder, about 30 percent had intermittent problems with incontinence, and 20 percent still needed to use a urinary catheter.