Paraplegia due to Anterior Spinal Artery Stroke: Rehabilitative Program on Lower Extremity Weakness and Locomotor Function

Andrea Santamato

doi:10.4172/2329-9096.1000118

Abstract

Background: Spinal cord ischemia in the absence of trauma with a stroke in the territories of anterior spinal artery (ASA) attributed to paradoxical embolism through patent foramen ovale (PFO) is a rare event. Rehabilitative treatment is focused on the improvement of lower limbs muscle torque to consent a recovery of balance and gait. Methods: Case report of a 43-year-old woman with paraplegia after ASA stroke due to PFO Results: A 43-year-old woman was hospitalized for sudden and progressive increase of weakness of lower limbs few hours after evacuation effort by using the Valsalva maneuver. Neurological and physiatric examination revealed paraplegia, lower limbs dysesthesia, and hesitancy with delayed bowel emptying. Spine-MRI showed D12–L1 anterolateral cord ischemia. Transcranial doppler sonography examination disclosed a PFO with moderate right-left shunt. During hospitalization, the patient was treated with steroids and acetylsalicylic acid drugs. Then, she was transferred to the Department of Physical Medicine and Rehabilitation and submitted to intensive rehabilitation of balance and gait. First, the patient was treated to increase the lower limbs torque and trunk control using also functional electrical stimulation (FES) cycling. Then, she performed an aquatic treadmill increasing contemporaneously both the weight support on the paretic legs than gait velocity. Motor and urinary symptoms disappeared in 30 days. Conclusion: After diagnostic work-up, PFO was considered the only cause of disease, suggesting that this was a case of ASA due to probable paradoxical embolism. The patient was treated with pharmacological therapy and a rehabilitative protocol with good recovery of locomotor function and muscle strength.

Highlights

Spinal cord ischemia is a rare disease, and the natural history and pathogenesis remain largely unknown, even if in the absence of trauma, sudden development of symptoms referable to lesions of the spinal tract suggests an infarct or hemorrhagic lesion of the spinal cord [1]
It is known the possibility that the spinal cord infarct in the anterior spinal artery distribution is attributed to paradoxical embolism through a patent foramen ovale (PFO) [3]
The clinical picture of anterior spinal artery (ASA) syndrome varies with the level of ischemia causing muscle weakness, grading from paresis to tetra- or paraplegia with loss of the sensation of pain, temperature, touch and loss of sphincter control

Summary

Results

A 43-year-old woman was hospitalized for sudden and progressive increase of weakness of lower limbs few hours after evacuation effort by using the Valsalva maneuver. Neurological and physiatric examination revealed paraplegia, lower limbs dysesthesia, and hesitancy with delayed bowel emptying. The patient was treated with steroids and acetylsalicylic acid drugs. She was transferred to the Department of Physical Medicine and Rehabilitation and submitted to intensive rehabilitation of balance and gait. The patient was treated to increase the lower limbs torque and trunk control using functional electrical stimulation (FES) cycling. She performed an aquatic treadmill increasing contemporaneously both the weight support on the paretic legs than gait velocity.

Conclusion

Introduction

Discussion