Abstract WP32: A Dissection of Spinal Cord Infarction: Cases With Rare Features and Innovative Treatments

Abstract

Spinal cord infarction (SCI) poses a unique set of diagnostic and therapeutic challenges to clinicians. The condition carries high risk for severe disability if not promptly addressed, yet there is no consensus on the threshold for patients to be screened with emergent MRI or receive acute interventions such as IV-thrombolysis or endovascular therapy, in large part due to limited case data and a lack of statistically powered trials or formal guidelines. Moreover, multiple distinct pathologic processes can cause SCI, and there remains limited understanding of which patient cohorts may be most susceptible to each stroke mechanism or respond favorably to the various possible treatments. Here, we present an in-depth analysis of a series of 11 SCI cases presenting to a network of 3 hospitals at a large academic center in New York City over a 5-year period to compare presenting symptoms, etiology, acute treatment strategy, and clinical outcome. We review the results of 9 patients who were evaluated with digital subtraction angiography (DSA), including 2 patients receiving different multiple drug regimens of acute intra-arterial therapies. One patient was also found eligible and treated with IV-thrombolysis. In these data we also identify multiple patients who experienced SCI in the setting of sickle cell disease and track their functional outcomes after being treated with exchange transfusion or anticoagulation, as well as 2 young patients with apparent heritable causes of hypercoagulability leading to their ischemic events. These preliminary data suggest that underlying conditions of hypercoagulability and arterial dissection are more predominant drivers of SCI than traditional mechanisms of cerebral ischemic stroke such as large vessel atherosclerosis or cardioembolism, and that heritable causes may be more prevalent in patients with SCI compared to other stroke patients. We propose these findings as a basis for designing a larger scale study for result confirmation.