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October 15, 2018

First Diagnostic Criteria Determined for Spinal Cord Strokes

By Advancing the Science contributor

These MRI images of spinal cross-sections show several different potential characteristics of spinal cord stroke.

Mayo Clinic researchers have outlined diagnostic criteria for determining spinal cord strokes. One reviewer described their research, published in the Journal of the American Medical Association Neurology, as “a seminal paper” that will help diagnose spinal cord strokes, which oftentimes are misdiagnosed.

“Spinal cord strokes can be confidently diagnosed by following the diagnostic criteria we have developed, which helps guide acute treatment and future research for this patient population,” says Nicolas Zalewski, M.D. (@nzalewski2), Mayo Clinic neurologist and first author on the paper. “It is common for patients with a spinal cord stroke to be misdiagnosed with an inflammatory spinal cord disease.”

“a seminal paper” that will help diagnose spinal cord strokes, which oftentimes are misdiagnosed.

If patients with spinal cord strokes are misdiagnosed, they could be exposed to unnecessary and possibly harmful interventions, such as aggressive immunotherapies, as well as missed treatment opportunities and secondary stroke prevention.

What is a spinal cord stroke?

A spinal cord stroke occurs when the blood supply to the spinal cord stops. 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 able to send nerve impulses (messages) to the rest of the body. These nerve impulses are vital for controlling activities of the body, such as moving the arms and legs, and allowing organs to work properly.

Spinal strokes are much less common than strokes that affect the brain, accounting for less than two percent of all strokes.

The research team evaluated the electronic medical records of 133 Mayo Clinic patients with a spontaneous spinal cord stroke, or spinal cord infarction, over a period of 20 years from 1997-2017.

“Our study found typical clinical and imaging features that can differentiate spinal cord stroke from alternative causes of spinal cord disease,” Dr. Zalewski said. These features were formulated into diagnostic criterial that focus on four primary components for diagnosing spinal cord infarction:

  • Severe spinal cord symptoms that develop within 12 hours or less
  • MRI showing no spinal cord compression and typical features of spinal cord infarction
  • Spinal fluid with no inflammation
  • Lack of a likely alternative diagnosis

Of the 133 patients included in the Mayo study, 29.3 percent of the patients had definite spinal cord infarction; 62.4 percent had probable spinal cord infarction and 7.5 percent had possible spinal cord infarction. One patient did not meet the diagnostic criteria.

Dr. Zalewski notes that the new diagnostic criteria for spinal cord stroke helps physicians in three ways:

  1. Improved diagnostic certainty helping delineate the correct treatment approach while avoiding unnecessary tests and potentially harmful treatments used for alternative spinal cord diseases.
  2. Increased recognition and diagnosis of the condition which will further highlight this under recognized condition in the neurology community.
  3. A foundation to build upon for future research including clinical trials to help treat patients with this often disabling condition.

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Tags: neurology, News, Nicholas Zalewski, spinal cord, stroke

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