Infarto medular diagnóstico clínico, eletrofisiológico e laboratorial: clinical, electrophysiological and laboratory diagnosis

Souza, Silvia Mazzali J. de; Pastro, Paulo César; Costa, Arthur J.; Seixas, Ricardo Ranieri; Bittencourt, Paulo R. M.

doi:10.1590/S0004-282X1990000400013

Resumos

Na literatura neurológica internacional, mas principalmente na latino-americana, infartos medulares têm sido raramente descritos exceto em relação com cirurgia da aorta abdominal. O obietivo do presente trabalho foi relatar critérios de diagnóstico clínico, eletrofisiológico, de imagem e laboratorial que levaram a este diagnóstico em 17 casos entre 1982 e 1989, um deles relacionado com cirurgia da aorta abdominal. Estes resultados demonstram que infarto medular não é patologia tão rara, e que seu pouco reconhecimento se deve a alto limiar diagnóstico, talvez relacionado ao fato de não haver tratamento específico.

In the international, but more so in the latin-american, medical literature infarction of the spinal cord has been rarely described except in relationship with surgery of the abdominal aorta. The objetive of this report is to describe, the diagnostic approach including clinical, electrophysiological, imaging and cerebrospinal fluid criteria. With these methods 17 cases were diagnosed between 1982 and 1989, one related to surgery of the abdominal aorta. This series suggests that infarction of the spinal cord is a more common clinical entity than presently considered. Its rarity may be due to a high diagnostic threshold related to the perception that there is no specific therapy.

Silvia Mazzali J. de Souza^I; Paulo César Pastro^I; Arthur J. Costa^II; Ricardo Ranieri Seixas^III; Paulo R. M. Bittencourt^IV

^IAcadêmico Estagiário - Unidades de Neurologia Clínica e Neurofisiologia Clínica, Hospital Nossa Senhora das Graças; Centro-Dia, Clínica de Recuperação; Centro Diagnóstico de Curitiba

^IIResidente em Neurologia - Unidades de Neurologia Clínica e Neurofisiologia Clínica, Hospital Nossa Senhora das Graças; Centro-Dia, Clínica de Recuperação; Centro Diagnóstico de Curitiba

^IIINeurofisiologista Clínico - Unidades de Neurologia Clínica e Neurofisiologia Clínica, Hospital Nossa Senhora das Graças; Centro-Dia, Clínica de Recuperação; Centro Diagnóstico de Curitiba

^IVChefe da Unidade - Unidades de Neurologia Clínica e Neurofisiologia Clínica, Hospital Nossa Senhora das Graças; Centro-Dia, Clínica de Recuperação; Centro Diagnóstico de Curitiba

RESUMO

Na literatura neurológica internacional, mas principalmente na latino-americana, infartos medulares têm sido raramente descritos exceto em relação com cirurgia da aorta abdominal. O obietivo do presente trabalho foi relatar critérios de diagnóstico clínico, eletrofisiológico, de imagem e laboratorial que levaram a este diagnóstico em 17 casos entre 1982 e 1989, um deles relacionado com cirurgia da aorta abdominal. Estes resultados demonstram que infarto medular não é patologia tão rara, e que seu pouco reconhecimento se deve a alto limiar diagnóstico, talvez relacionado ao fato de não haver tratamento específico.

SUMMARY

In the international, but more so in the latin-american, medical literature infarction of the spinal cord has been rarely described except in relationship with surgery of the abdominal aorta. The objetive of this report is to describe, the diagnostic approach including clinical, electrophysiological, imaging and cerebrospinal fluid criteria. With these methods 17 cases were diagnosed between 1982 and 1989, one related to surgery of the abdominal aorta. This series suggests that infarction of the spinal cord is a more common clinical entity than presently considered. Its rarity may be due to a high diagnostic threshold related to the perception that there is no specific therapy.

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Dr. Paulo R. M. Bittencourt - Unidade de Neurologia Clínica, Hospital Nossa Senhora das Graças - Rua Alcides Munhoz 433 - 80510 Curitiba PR - Brasil.

1. Adams JH, Cameron HM - Obstetrical paralysis due to ischemia of the spinal cord. Arch Dis Child 40:93, 1965.
2. Ahmann PA, Smith A, Schwartz JF, Clark DB - Spinal cord infarction due to minor trauma in children. Neurology 25:301, 1975.
3. Anderson NE, Willoughby EW - Infarction of the conus medullaris. Ann Neurol 21:470, 1987.
4. Brewer LA III, Fosburg RG, Mulder GA, Verska JJ - Spinal cord complication following surgery of coarctation of the aorta. J Thorac Cardiovase Surg 64:368, 1972.
5. Chung MF - Thrombosis of the spinal vessels in sudden syphilitic paraplegia. Arch Neurol Psychiat 16:761, 1926.
6. Coles JC, Ahmed SN, Mehta HV, Kaufmann JCE - Role of free radical scavenger in protection of spinal cord during ischemia. Ann Thorac Surg 41:551, 1986.
7. Coupland GAE, Reeve TS - Paraplegia: a complication of excision of abdominal aortic aneurysm. Surgery 64:878, 1968.
8. Crosby EC, Lawer EW, Humphrey T - Anatomy of the nervous system. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 1. Revised Edition 1985. Harper & Row, Philadelphia. 1985.
9. De Meyer W - Anatomy and clinical neurology of the spinal cord. In Baker AB, Joynt RJ eds): Clinical Neurology, Vol 1. Revised Edition 1985. Harper & Row, Philadelphia, 1979.
10. Decroix JP, Lacroix CC, Lapresle J - Syndrome de Brown-Séquard dü à un infarctus spinal. Rev Neurol (Paris) 140:585, 1984.
11. Faden AI, Jacobs TP, Smith MT, Zivin JA - Naloxene in experimental spinal cord ischemia: dose-response studies. Eur J Clin Pharmacol 103:115, 1984.
12. Feigin T, Popoff N, Adachi M - Fibrocartilagenous venous emboli to the spinal cord with necrotic Myelopathy. J Neurol Exp Neuropathol 24:63, 1964.
13. Garland H, Greenberg J, Harriman DGF - Infarction of the spinal cord. Brain 89:645, 1966.
14. Giangaspero F, Dondi C, Scarani P, Zanetti G, Marchesini G - Degeneration of the corticospinal tract following portosystemic shunt associated with spinal cord infarction. Virchows Arch (Pathol Anat) 406:475, 1985.
15. Gibb WRG, Aurry P, Lees AJ - Giant cell arteritis with spinal cord infarction and basilar artery trombosis. J Neurol Neurosurg Psychiat 48:945, 1985.
16. Gillilan LA - Veins of the spinal cord. Neurology 20:860, 1970.
17. Harris RE, Reimer KA. Crain BJ, Becsey I>, Oldham HN Jr - Spinal cord infarction following intraaortic ballon support. Ann Thorac Surg 42:206, 1986.
18. Henson RA, Parsons M - Ischaemia lesions of the spinal cord: an illustrated review. QJ Med 36:205, 1967.
19. Herrick MK, Mills PE Jr - Infarction of the spinal cord: two cases of selective gray matter involvement secondary to lasymptomatic aortic disease. Arch Neurol 24:228, 1971.
20. Horton JA, Latckaw RE, Gold LHA, Pang D - Embolization of intramedullary arteriovenous malformations of the spinal cord. AJNR 7:113, 1986.
21. Hughes JT - Venous infarction of the spinal cord. Neurology 21:794, 1971.
22. Hughes JT, Brownell B - Spinal cord ischemia due to arterosclerosis. Arch Neurol 15:189, 1966.
23. Hughes JT, Brownell B - Cervical spondylosis complicated by anterior spinal artery thrombosis. Neurology 14:1073, 1986.
24. Hughes JT, Macintyre AG - Spinal cord infarction occurring during thoraco-lumbar sympathectomy. J Neurol Neurosurg Psychiat 26:418, 1963.
25. Kaisary AV, Smith P - Spinal cord ischemia after ligation of both internal iliac arteries during radical cystoprostatectomy. Urology 25:395, 1985.
26. Kaplan BJ, Friedman WA, Alexander JA, Hampson SR - Somatosensory evoked potenciais monitoring of spinal cord ischemia during aortic operations. Neurosurgery 19:82, 1986.
27. Kim RC, Smith HR, Henbest ML, Choi BH - Nonhemorrhagic venous infarction of the spinal cord. Ann Neurol 15:379, 1984.
28. Kochar G, Kotler MN, Hartmann J, Goldberg SE, Parry W, Parameswaran R, Scanlon M - Thrombosed aorta resulting in spinal cord ischemia and paraplegia in ischemia cardiomyopathy. An Heart J 113:1510, 1987.
29. Koehler PJ, Wingaard PRA - Brown-Séquard syndrome due to spinal cord infarction after subclavian vein catheterisation. Lancet 2:914, 1986.
30. Laguna J, Cravioto H - Spinal cord infarction secondary to occlusion of the anterior spinal artery. Arch Neurol 28:134, 1973.
31. Laschinger JC, Izumoto H, Kouchoukos NT - Evolving concepts in prevention of spinal cord injury during operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 44:665, 1987.
32. Mair WGP, Folkerts JF - Necrosis of the spinal cord due to thrombophlebitis (subacute necrotic myelitis). Brain 76:563 1953.
33. Marvasti MA, Meyer JA, Ford BE, Parker FB Jr - Spinal cord ischemia following operation for traumatic aortic transection. Ann Thorac Surg 42:425, 1986.
34. Moossy J - Vascular diseases of the spinal cord. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 3. Revised Edition 1985. Harper & Row, Philadelphia, 1976.
35. Mulder DW, Dale AJD - Spinal cord tumors and disks. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 3. Revised Edition 1985. Harper & Row, Philadelphia, 1975.
36. Nielsen BP - Ischemia injury to the spinal cord as a complication to abdominal aortic surgery. Acta Chir Scand 151:433, 1985.
37. Petermann AF, Yoss RE, Corbin KB - The syndrome of occlusion of the anterior spinal artery. Proc Staff Meetings Mayo Clin 33:31, 1958.
38. Pollock JC, Jamieson MP, McWillian R - Somatosensory evoked potenciais in the detection of spinal cord ischemia in aortic coartation repair. Ann Thorac Surg 41:251, 1986.
39. Rao RK, Donnenfeld H, Chusid JG, Valdez S - Acute myelopathy secondary to spinal venous thrombosis. J Neurol Sci 56:107, 1982.
40. Ross RT - Spinal cord infarction in disease and surgery of the aorta. J Canad Sci Neurol 12:289, 1985.
41. Shukla RB, Lynch VP - Spinal cord ischaemia following repair of the ruptured thoracic aorta: a sucessful outcome. Isr J Med Sci 54:35, 1985.
42. Skillman JJ, Zervas NT, Weitraub RM, Mayman CI - Paraplegia after resection of aneurysms of the abdominal aorta. N Engl J Med 281:422, 1969.
43. Spalding JMK, Nelson E - The autonomic nervous system. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 4. Revised Edition 1985. Harper & Row, Philadelphia, 1985.
44. Srigley JR, Lambert CD, Bilbao JM, Pritzker KPH - Spinal cord infarction secondary to invertebral disc embolism. Ann Neurol 9:296, 1981.
45. SteegmanAT - Syndrome of the anterior spinal artery. Neurology 26:15, 1976.
46. Stutesman JL, Houston JM, Wayne DA - Post-surgical ischemic myelopathy. Paraplegia 25:23, 1987.
47. Wells CEC - Clinical aspects of spinovascular disease. Proc R Soc Med 59:791, 1966.
48. Wolman L, Bradshaw P - Spinal cord embolism. J Neurol Neurosurg Psychiat 30:446, 1967.

Infarto medular diagnóstico clínico, eletrofisiológico e laboratorial

Spinal cord infarction: clinical, electrophysiological and laboratory diagnosis

Datas de Publicação

Publicação nesta coleção
19 Maio 2011
Data do Fascículo
Dez 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams JH, Cameron HM - Obstetrical paralysis due to ischemia of the spinal cord. Arch Dis Child 40:93, 1965.

[2] 2. Ahmann PA, Smith A, Schwartz JF, Clark DB - Spinal cord infarction due to minor trauma in children. Neurology 25:301, 1975.

[3] 3. Anderson NE, Willoughby EW - Infarction of the conus medullaris. Ann Neurol 21:470, 1987.

[4] 4. Brewer LA III, Fosburg RG, Mulder GA, Verska JJ - Spinal cord complication following surgery of coarctation of the aorta. J Thorac Cardiovase Surg 64:368, 1972.

[5] 5. Chung MF - Thrombosis of the spinal vessels in sudden syphilitic paraplegia. Arch Neurol Psychiat 16:761, 1926.

[6] 6. Coles JC, Ahmed SN, Mehta HV, Kaufmann JCE - Role of free radical scavenger in protection of spinal cord during ischemia. Ann Thorac Surg 41:551, 1986.

[7] 7. Coupland GAE, Reeve TS - Paraplegia: a complication of excision of abdominal aortic aneurysm. Surgery 64:878, 1968.

[8] 8. Crosby EC, Lawer EW, Humphrey T - Anatomy of the nervous system. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 1. Revised Edition 1985. Harper & Row, Philadelphia. 1985.

[9] 9. De Meyer W - Anatomy and clinical neurology of the spinal cord. In Baker AB, Joynt RJ eds): Clinical Neurology, Vol 1. Revised Edition 1985. Harper & Row, Philadelphia, 1979.

[10] 10. Decroix JP, Lacroix CC, Lapresle J - Syndrome de Brown-Séquard dü à un infarctus spinal. Rev Neurol (Paris) 140:585, 1984.

[11] 11. Faden AI, Jacobs TP, Smith MT, Zivin JA - Naloxene in experimental spinal cord ischemia: dose-response studies. Eur J Clin Pharmacol 103:115, 1984.

[12] 12. Feigin T, Popoff N, Adachi M - Fibrocartilagenous venous emboli to the spinal cord with necrotic Myelopathy. J Neurol Exp Neuropathol 24:63, 1964.

[13] 13. Garland H, Greenberg J, Harriman DGF - Infarction of the spinal cord. Brain 89:645, 1966.

[14] 14. Giangaspero F, Dondi C, Scarani P, Zanetti G, Marchesini G - Degeneration of the corticospinal tract following portosystemic shunt associated with spinal cord infarction. Virchows Arch (Pathol Anat) 406:475, 1985.

[15] 15. Gibb WRG, Aurry P, Lees AJ - Giant cell arteritis with spinal cord infarction and basilar artery trombosis. J Neurol Neurosurg Psychiat 48:945, 1985.

[16] 16. Gillilan LA - Veins of the spinal cord. Neurology 20:860, 1970.

[17] 17. Harris RE, Reimer KA. Crain BJ, Becsey I>, Oldham HN Jr - Spinal cord infarction following intraaortic ballon support. Ann Thorac Surg 42:206, 1986.

[18] 18. Henson RA, Parsons M - Ischaemia lesions of the spinal cord: an illustrated review. QJ Med 36:205, 1967.

[19] 19. Herrick MK, Mills PE Jr - Infarction of the spinal cord: two cases of selective gray matter involvement secondary to lasymptomatic aortic disease. Arch Neurol 24:228, 1971.

[20] 20. Horton JA, Latckaw RE, Gold LHA, Pang D - Embolization of intramedullary arteriovenous malformations of the spinal cord. AJNR 7:113, 1986.

[21] 21. Hughes JT - Venous infarction of the spinal cord. Neurology 21:794, 1971.

[22] 22. Hughes JT, Brownell B - Spinal cord ischemia due to arterosclerosis. Arch Neurol 15:189, 1966.

[23] 23. Hughes JT, Brownell B - Cervical spondylosis complicated by anterior spinal artery thrombosis. Neurology 14:1073, 1986.

[24] 24. Hughes JT, Macintyre AG - Spinal cord infarction occurring during thoraco-lumbar sympathectomy. J Neurol Neurosurg Psychiat 26:418, 1963.

[25] 25. Kaisary AV, Smith P - Spinal cord ischemia after ligation of both internal iliac arteries during radical cystoprostatectomy. Urology 25:395, 1985.

[26] 26. Kaplan BJ, Friedman WA, Alexander JA, Hampson SR - Somatosensory evoked potenciais monitoring of spinal cord ischemia during aortic operations. Neurosurgery 19:82, 1986.

[27] 27. Kim RC, Smith HR, Henbest ML, Choi BH - Nonhemorrhagic venous infarction of the spinal cord. Ann Neurol 15:379, 1984.

[28] 28. Kochar G, Kotler MN, Hartmann J, Goldberg SE, Parry W, Parameswaran R, Scanlon M - Thrombosed aorta resulting in spinal cord ischemia and paraplegia in ischemia cardiomyopathy. An Heart J 113:1510, 1987.

[29] 29. Koehler PJ, Wingaard PRA - Brown-Séquard syndrome due to spinal cord infarction after subclavian vein catheterisation. Lancet 2:914, 1986.

[30] 30. Laguna J, Cravioto H - Spinal cord infarction secondary to occlusion of the anterior spinal artery. Arch Neurol 28:134, 1973.

[31] 31. Laschinger JC, Izumoto H, Kouchoukos NT - Evolving concepts in prevention of spinal cord injury during operations on the descending thoracic and thoracoabdominal aorta. Ann Thorac Surg 44:665, 1987.

[32] 32. Mair WGP, Folkerts JF - Necrosis of the spinal cord due to thrombophlebitis (subacute necrotic myelitis). Brain 76:563 1953.

[33] 33. Marvasti MA, Meyer JA, Ford BE, Parker FB Jr - Spinal cord ischemia following operation for traumatic aortic transection. Ann Thorac Surg 42:425, 1986.

[34] 34. Moossy J - Vascular diseases of the spinal cord. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 3. Revised Edition 1985. Harper & Row, Philadelphia, 1976.

[35] 35. Mulder DW, Dale AJD - Spinal cord tumors and disks. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 3. Revised Edition 1985. Harper & Row, Philadelphia, 1975.

[36] 36. Nielsen BP - Ischemia injury to the spinal cord as a complication to abdominal aortic surgery. Acta Chir Scand 151:433, 1985.

[37] 37. Petermann AF, Yoss RE, Corbin KB - The syndrome of occlusion of the anterior spinal artery. Proc Staff Meetings Mayo Clin 33:31, 1958.

[38] 38. Pollock JC, Jamieson MP, McWillian R - Somatosensory evoked potenciais in the detection of spinal cord ischemia in aortic coartation repair. Ann Thorac Surg 41:251, 1986.

[39] 39. Rao RK, Donnenfeld H, Chusid JG, Valdez S - Acute myelopathy secondary to spinal venous thrombosis. J Neurol Sci 56:107, 1982.

[40] 40. Ross RT - Spinal cord infarction in disease and surgery of the aorta. J Canad Sci Neurol 12:289, 1985.

[41] 41. Shukla RB, Lynch VP - Spinal cord ischaemia following repair of the ruptured thoracic aorta: a sucessful outcome. Isr J Med Sci 54:35, 1985.

[42] 42. Skillman JJ, Zervas NT, Weitraub RM, Mayman CI - Paraplegia after resection of aneurysms of the abdominal aorta. N Engl J Med 281:422, 1969.

[43] 43. Spalding JMK, Nelson E - The autonomic nervous system. In Baker AB, Joynt RJ (eds): Clinical Neurology, Vol 4. Revised Edition 1985. Harper & Row, Philadelphia, 1985.

[44] 44. Srigley JR, Lambert CD, Bilbao JM, Pritzker KPH - Spinal cord infarction secondary to invertebral disc embolism. Ann Neurol 9:296, 1981.

[45] 45. SteegmanAT - Syndrome of the anterior spinal artery. Neurology 26:15, 1976.

[46] 46. Stutesman JL, Houston JM, Wayne DA - Post-surgical ischemic myelopathy. Paraplegia 25:23, 1987.

[47] 47. Wells CEC - Clinical aspects of spinovascular disease. Proc R Soc Med 59:791, 1966.

[48] 48. Wolman L, Bradshaw P - Spinal cord embolism. J Neurol Neurosurg Psychiat 30:446, 1967.