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  4. Spontaneous spinal cord infarction: a systematic review

Spontaneous spinal cord infarction: a systematic review

BMJ Neurol Open, 2024 · DOI: 10.1136/bmjno-2024-000754 · Published: May 20, 2024

Spinal Cord InjuryNeurologyResearch Methodology & Design

Simple Explanation

Spontaneous spinal cord infarction (SCInf) is a rare condition that can lead to acute neurological problems. There is currently no clear agreement on how to diagnose it, which can make it difficult for doctors. This review looks at existing studies on spontaneous SCInf, focusing on its causes, how it's diagnosed, treatment options, and how patients recover. The review found that vascular risk factors like high blood pressure and smoking are common in people with SCInf. MRI scans, especially with diffusion-weighted imaging (DWI), are helpful in confirming the diagnosis. Most patients are expected to regain the ability to walk, with or without assistance. This study highlights the need for more research to create standard diagnostic criteria and treatment guidelines for spontaneous SCInf. It also suggests a diagnostic and treatment approach, and underscores the need for further research in order to establish definitive diagnostic criteria and treatment strategies.

Study Duration
Mean follow-up 34.8 (±12.2) months
Participants
440 patients
Evidence Level
Systematic Review

Key Findings

  • 1
    Vascular risk factors, especially hypertension, play a significant role in spontaneous SCInf.
  • 2
    MRI with DWI is valuable in confirming the diagnosis of spontaneous SCInf.
  • 3
    Neurological recovery is expected, with most patients regaining ambulation.

Research Summary

This systematic review analysed 33 studies with 440 patients to understand spontaneous spinal cord infarction (SCInf). The review found that hypertension, smoking, dyslipidaemia, and diabetes were common vascular risk factors. MRI with DWI supported the diagnosis in 81% of cases, and most patients regained ambulation at follow-up. The study concludes that vascular risk factors are important in SCInf, DWI-MRI aids diagnosis, and neurological recovery with ambulation is likely. More research is needed for diagnostic criteria and treatment guidelines.

Practical Implications

Improved Diagnosis

The use of DWI along with an MRI may help in confirming the diagnosis.

Treatment Strategies

Pharmacological treatment with platelet aggregation inhibitors in the aftermath of spontaneous SCInf is recommended.

Rehabilitation Services

Specialized multidisciplinary rehabilitation services are needed with the capacity to manage patients in the long term.

Study Limitations

  • 1
    Small sample sizes
  • 2
    Intermediate to high risks of bias
  • 3
    Observational designs on retrospective cohorts or case series

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