Spinal geçici iskemik atak: Radiküler ağrılı geçici zaafın nadir ve tedavi edilebilir bir nedeni

Spinal kordun geçici iskemik atağı (TIA-sc) çok nadir görülür ve ani başlangıçlı felç, duyusal kayıp, sırt ağrısı ile karakterizedir. Akut ağrılı paraplejisi olan ve birkaç saat içinde düzelen semptomları olan bir hastayı sunuyoruz. Literatür taramasında 10 hasta belirledik. Bunların beşi erkekti, ortalama yaş 53.8 idi. Paraparezi / pleji hepsinde mevcuttu. Sadece iki hastada radiküler ağrı yoktu. Vasküler risk faktörleri beş hastada hipertansiyon, beş hastada sigara ve bir hastada diabetes mellitus idi. TIA dönemi 1 dakika-24 saat arasında değişmekteydi. En yaygın etiyoloji aort diseksiyonu idi (n=6). Dört hastada aort trombozu vardı. Altı hasta tıbbi ve cerrahi yöntemlerle tedavi edildi, diğer dördü sadece tıbbi olarak tedavi edildi. Ağrılı kısa süreli/kalıcı akut spinal sendromlarda spinal kord iskemisi ve aorta hastalıkları akılda tutulmalıdır.

Spinal transient ischemic attack: Rare and treatable cause of transient weakness with radicular pain

Transient ischemic attack (TIA) of spinal cord (SC) is very rare and characterized by sudden onset of paralysis, sensory loss, back pain. We present a patient with acute painful paraplegia and symptoms resolved within a few hours. We identified 10 patients in literature search. Five of them were male, the mean age of patients was 53.8. Paraparesis/pleji was present in all. Only two patients did not have radicular pain. Vascular risk factors were hypertension in five patients, smoking in five and diabetes mellitus in one. TIA period ranged from 1 min to 24 h. The most common etiology was aortic dissection (n=6). Four patients had aortic thrombosis. Six patients were treated with medical and surgical methods; other four were treated with only medically. SC ischemia and aortic diseases should be kept in mind in short term/persistent acute spinal syndromes with pain.

PDF

___

1. Masson C, Pruvo JP, Meder JF, Cordonnier C, Touzé E, De La Sayette V, et al. Spinal cord infarction: Clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry 2004;75(10):1431–5. [CrossRef ]
2. Millichap JJ, Sy BT, Leacock RO. Spinal cord infarction with multiple etiologic factors. J Gen Intern Med 2007;22(1):151–4. [CrossRef ]
3. Hussain MS, Shuaib A, Siddiqi ZA. Spinal cord transient ischemic attacks: A possible role for abciximab. Neurology 2005;64(4):761–2. [CrossRef ]
4. Zingler VC, Strupp M, Brüning R, Lauterjung L, Waggershausen T, Brückmann H, et al. Recurrent exertion-induced spinal cord ischemia due to infrarenal aortic occlusion. J Neurol 2003;250(8):998–1000. [CrossRef ]
5. Costa S, Marques J, Barradas A, Valverde A. Transient spinal cord ischemia as presenting manifestation of polycythemia vera. Case Rep Neurol 2011;3(3):284–8. [CrossRef ]
6. Hsu YC, Lin CC. Paraparesis as the major initial presentation of aortic dissection: Report of four cases. Acta Neurol Taiwan 2004;13(4):192–7.
7. Joo JB, Cummings AJ. Acute thoracoabdominal aortic dissection presenting as painless, transient paraly sis of the lower extremities: A case report. J Emerg Med 2000;19(4):333–7. [CrossRef ]
8. van Zeggeren L, Waasdorp EJ, van de Worp BH, Meijer ST, Moll FL, de Borst GJ. Painless transient paraparesis as the solitary manifestation of aortic dissection. J Vasc Surg 2011;54(5):1481–4. [CrossRef ]
9. Syed MA, Fiad TM. Transient paraplegia as a presenting feature of aortic dissection in a young man. Emerg Med J 2002;19(2):174–5. [CrossRef ]
10. Altuwaijri M, Delis KT, Vrtiska T, Fulgham JR, Gloviczki P. Aortic fenestration for chronic aortic dissection type B complicated by transient ischemic attacks of spinal cord. J Vasc Surg 2006;44(1):186–93. [CrossRef ]
11. Tanaka T, Uemura K, Sugiura M, Ohishi H, Tomita M, Nagasaki F, et al. Transient paraplegia caused by acute aortic dissection--case report. Neurol Med Chir (Tokyo) 1990;30(1):54–8. [CrossRef ]
12. Guest JD, Griesdale DE, Marotta T. Thoracic disc herniation presenting with transient anterior spinal artery syndrome. A case report. Interv Neuroradiol 2000;6(4):327–31.
13. Salvador de la Barrera S, Barca-Buyo A, Montoto-Marqués A, Ferreiro-Velasco ME, Cidoncha-Dans M, Rodriguez-Sotillo A. Spinal cord infarction: Prognosis and recovery in a series of 36 patients. Spinal Cord 2001;39(10):520–5. [CrossRef ]
14. Sivadasan A, Alexander M, Patil AK, Mani S. Spectrum of clinicoradiological findings in spinal cord infarction: Report of three cases and review of the literature. Ann Indian Acad Neurol 2013;16(2):190–3. [CrossRef ]
15. Bradley WG. Neurology in clinical practice. In: Daroff RB, Fenichel GB, Jankovic J, Mazziotta JC, editors. 5th ed. Philadelphia: Elsevier; 2008. p.51E.
16. Cheng MY, Lyu RK, Chang YJ, Chen RS, Huang CC, Wu T, et al. Spinal cord infarction in Chinese patients. Clinical features, risk factors, imaging and prognosis. Cerebrovasc Dis 2008;26(5):502–8. [CrossRef ]
17. Zainal AA, Oommen G, Chew LG, Yusha AW. Acute aortic occlusion: The need to be aware. Med J Malaysia 2000;55:29– 32.
18. Diener HC, Bogousslavsky J, Brass LM, Cimminiello C, Csiba L, Kaste M, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): Randomised, double-blind, placebo-controlled trial. Lancet 2004;364(9431):331-7. [CrossRef ]