Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

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.


Related resources:

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

On November 26, 2020 i was diagnosed with a spinal cord stroke, in which on 11/24/20 i had major pain in chest also in shoulder blades and neck area. i was sent to a level 1 Trauma Center for treatment for cardiac in which this is where my cardiologist is located. ( prior heart stent in 2/18)! after heart cath on 11/25 i was sent home that evening because heart cath showed heart was fine! later in the evening i began to have the same pain as on 11/24 but it was much more intense and unbearable! i returned to our local ER that was approx a 15 min drive from my home, i walked to my car at home and by the time i arrived at the ER i had paralysis in both arms, hands and legs i could not get into the wheelchair! The ER done a cat scan of my head for stroke which came back normal, give me meds for my pain and approx 4 hours later had me transported again to the same Level 1 Trauma center (Ft. Sanders, Knoxville Tn)! after receiving an intense 2 hour MRI of my head and complete spine i was diagnosed to have had a spinal cord stroke at this time even though my original MRI didnt show nothing,but my symptoms were. On 12/03 i was transferred to PATRICIA NEAL REHAB CENTER( located in same hospital)! in which during the time i was in the Ft. Sanders i remained numb just below my nipple line all way thru both legs and feet i have gained most of my strength in arms and hands! i have continued loss throughout the use of my bladder (i continue to have to self cath), Once i was admitted into rehab the Doctor ordered an MRI of my thoracic area of spine in which came back as “shadowing” in that area, but no answers to why or what has caused this to me also i did have a spinal tap that was sent to the Mayo Clinic ( somewhere to my understanding) in which it came back clear, on 1/31/21 i had another MRI of my Head and Cervical part of my spine in which showed a confirmation of upper thoracic and lower cervical with shadowing on this area of spine. The head was clear again and the doctors pretty well ruled out MS! At this point i am at loss what is left to do with as the doctors are scratching their heads on my case as to why this occurred and what may have caused it so on my part its frustrating not knowing what or why and could this be fixed or what’s next! I am doing physical therapy at a local rehab center at present! So I suppose i am asking for assistance in what and if anyone there could assist with this case?? I would deeply appreciate your response on this issue, PLEASE THANK YOU! HAROLD EATON!

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