The arterial blood supply of the human spinal cord

Vascular mechanisms in the pathophysiology of human spinal cord injury

Vascular injury plays an important role in the primary and secondary injury mechanisms that cause damage to the acutely traumatized spinal cord. To understand the pathophysiology of human spinal cord injury, the authors investigated the vascular system in three uninjured human spinal cords using silicone rubber microangiography and analyzed the histological findings related to vascular injury in nine acutely traumatized human spinal cords obtained at autopsy. The interval from spinal cord injury to death ranged from 20 minutes to 9 months. The microangiograms of the uninjured human cervical cords demonstrated new information about the sulcal arterial system and the pial arteries. The centrifugal sulcal arterial system was found to supply all of the anterior gray matter, the anterior half of the posterior gray matter, approximately the inner half of the anterior and lateral white columns, and the anterior half of the posterior white columns. Traumatized spinal cord specimens in the acute stage (3-5 days postinjury) showed severe hemorrhages predominantly in the gray matter, but also in the white matter. The white matter surrounding the hemorrhagic gray matter showed a variety of lesions, including decreased staining, disrupted myelin, and axonal and periaxonal swelling. The white matter lesions extended far from the injury site, especially in the posterior columns. There was no evidence of complete occlusion of any of the larger arteries, including the anterior and posterior spinal arteries and the sulcal arteries. However, occluded intramedullary veins were identified in the degenerated posterior white columns. In the chronic stage (3-9 months postinjury), the injured segments showed major tissue loss with large cavitations, whereas both rostral and caudal remote sites showed well-demarcated necrotic areas indicative of infarction mainly in the posterior white columns. Obstruction of small intramedullary arteries and veins by the initial mechanical stress or secondary injury mechanisms most likely produced these extensive white matter lesions. Our studies implicate damage to the anterior sulcal arteries in causing the hemorrhagic necrosis and subsequent central myelomalacia at the injury site in acute spinal cord injury in humans.

Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study

Although most vascular abnormalities of the spinal cord are now ascribed to an abnormal communication between a dural artery and a medullary vein on the dura near a sensory nerve root, these lesions are too small for their anatomy to be demonstrated directly by spinal arteriography. Thus, it is unknown whether the site of dural arteriovenous shunting is an arteriovenous malformation (AVM), implying a congenital origin, or is a direct arteriovenous fistula (AVF), implying an acquired etiology. The authors treated six patients by en bloc resection of the involved dural root sleeve, proximal nerve root, and adjacent spinal dura. All of the patients presented with myelopathy and their arteriograms were consistent with a spinal dural vascular malformation. The lesions occurred between T-6 and T-12, levels at which clinical deficits from such resection are minimal. The dural artery or medullary vein associated with the vascular malformation was cannulated and a dilute solution of barium sulfate was injected during sequential fine-grain radiography. In all of the lesions the artery split into daughter vessels that coalesced one to three times to form a skein of arterial loops in the dura that invariably emptied into a medullary vein without an intervening capillary plexus. Several medium-to-small collateral vessels arising from adjacent intercostal or lumbar arteries were commonly present in the dura and converged at the site of the AVF to join a single medullary vein. These results show that spinal dural AVMs are direct AVFs that link the dural branch of the radiculo-medullary-dural artery with the intradural medullary vein. They also provide an anatomical explanation for the presence of a multiple segmental arterial supply and a single draining medullary vein of spinal dural AVFs, and the propensity for reestablishment of flow through the arteriovenous shunt after embolic occlusion.

Neurologic complications of reoperative and emergent abdominal aortic reconstruction

Patients undergoing emergent and reoperative abdominal aortic reconstructions are at increased risk for ischemic neurologic complications. Between 1986 and 1992 five patients sustained ischemic injuries to the spinal cord, nerve roots, or lumbosacral plexus. Four patients underwent reoperative aortic procedures including removal of an infected aortobifemoral graft and extra-anatomic bypass (n = 3) and aortofemoral graft revision for primary graft failure (n = 1). A fifth patient had a ruptured common iliac aneurysm repaired with an aortobifemoral graft. Three patients undergoing reoperative aortic procedures developed lower extremity paraparesis, patchy sensory deficits, and bowel and bladder dysfunction. Physical examination and electromyography localized the injury to the level of the cauda equina or lumbosacral plexus. The other patient in this group developed incomplete T12 paraplegia. Surgical reconstruction resulted in internal iliac exclusion in all four patients. The incidence of neurologic deficits during this study period was 18% (3/17) in patients requiring aortofemoral graft excision for infection. The patient undergoing aneurysm repair was noted to have paraplegia after surgery and died on the fourth postoperative day. Autopsy revealed evidence of multiple emboli to the kidneys, bowel, and spinal cord. Neurologic deficits after reoperative and emergent abdominal aortic reconstructions are uncommon but devastating complications. Of particular concern is the incidence of neurologic deficits after removal of aortofemoral grafts with disruption of collateral flow to the spinal cord and nerve roots. Consideration should be given to maintaining retrograde perfusion of at least one internal iliac artery via common femoral artery reconstruction in these patients.

Intravascular treatment of spinal arteriovenous malformations using a microcatheter--with special reference to serial xylocaine tests and intravascular pressure monitoring

Spinal arteriovenous malformations (spinal AVMs) are now treated using microcatheters and various embolic materials. Interventional techniques of this type are thought to be the first choice for treatment of spinal AVMs. In this study, we used the Tracker vascular access system and MAGIC catheter for intravascular treatment of spinal AVMs in order to avoid proximal occlusion. Notably, serial provocation tests using xylocaine (20 mg in bolus) and intermittent intravascular pressure monitoring in the anterior spinal artery were conducted during embolizations of five intramedullary AVMs. We used 150-350 microns polyvinyl alcohol particles (Ivalon) and/or polyvinyl alcohol (PVA) solutions as embolic materials for occlusion of these AVMs. Vital signs and neurologic functions were carefully monitored during and after the procedure. We were able totally to obliterate the nidus or markedly to reduce its size while preserving the anterior spinal artery in each of the patients. The xylocaine test was conducted an average of 2.6 times (2-4 times) during embolization. For the two patients who were treated with Ivalon and PVA solutions, the final provocation test became positive, and the embolization procedure was terminated. On the other hand, the remaining patients had a positive result on first xylocaine test and were treated with Ivalon alone. At the same time, intravascular pressure monitoring was performed via the microcatheter, which was located in the anterior spinal artery. The value of the intravascular systolic pressure prior to embolization was 71.6 +/- 14.1 mm Hg and it gradually increased during the procedure, and reached 99.6 +/- 12.6 mm Hg (90% of the systemic systolic blood pressure) by the conclusion of embolization. Serial xylocaine tests and intravascular pressure monitoring may be useful for the treatment of spinal AVMs fed mainly by the anterior spinal artery, and embolization with liquid embolic material should be terminated when the provocation test becomes positive and intravascular pressure increased to 90% of the systemic blood pressure.

Blood supply to the spinal cord: anatomic and physiologic correlations

Although the subject has been studied for many years, the clinician's understanding of the blood supply to the spinal cord is complicated by both confusing nomenclature and conflicting data. This review attempts to clarify prevailing thoughts on the arterial and venous structures in this clinically important area.

Anterior spinal artery syndrome

Three patients with symptoms due to the anterior spinal artery syndrome were treated by direct perfusion of dexamethasone sodium phosphate and urokinase into the artery of Adamkiewicz. Their symptoms were paraparesis with dissociated sensory loss and sphincter dysfunction, and there was no evidence of the possible cause. In the early phase of the disease, three consecutive injections were carried out with an interval of a week between each. All the patients made a good recovery.

Ischemic damage to the spinal cord following end-to-side aortobifemoral bypass

A patient presenting with urinary retention was found to have progressive spinal cord ischemia subsequent to an end-to-side aortobifemoral bypass for atherosclerotic disease. This serves as a vivid reminder of the possibility of this complication even in ischemic disease and that urinary retention may be the initial symptom of cord ischemia. A review of the literature on spinal cord ischemia following abdominal aortic surgery is presented.

[Intraneural distribution of the arteries in the cauda equina of newborn infants]

Mesoscopic study of the irrigation of the lumbosacral segment of the spinal cord and the roots of the cauda equina was carried out in corpses of 18 Brazilian newborns of either sex. Through the abdominal portion of the aorta nine newborns were injected with neoprene latex and the others were injected with a 5% solution of gelatin coloured with black Indian ink. The latter were cleared by the Spalteholz technique. Two types of arterial distribution were determined: (a) proximal and distal radicular arteries supplying the corresponding roots, which presented in their middle third an arterial low density, that is, hypo-irrigation; (b) segmental spinal arteries, varying in number, more frequent on the left side and having a larger caliber than that of the radicular arteries, accompanying the roots without providing collateral branches to the neural roots and anastomosed with the spinal arteries.

Superselective embolization of spinal arteriovenous malformations using the Tracker catheter

Eighteen patients with spinal arteriovenous malformations had been treated with conventional embolization, surgical removal, feeder ligation, and/or feeder coagulation between February 1985 and March 1990. The lesions included six glomus, four juvenile, three extramedullary, and five dural arteriovenous malformations or fistulas. Embolic therapy was conducted in 14 patients by introducing the tip of a catheter into the segmental arteries and injecting polyvinyl alcohol strips (500-1000 microns) (conventional embolization). Follow-up spinal angiography disclosed recanalization in 10 patients (71.4%) and the appearance of new feeding arteries in five patients (35.7%). We introduced the Tracker vascular access system in April 1990. Eight patients (four glomus, one juvenile, and three dural arteriovenous malformations) were treated with the minicatheter and Ivalon particles (150-350 microns). Five patients showed neurological improvement immediately after treatment. The other three patients had severe paraparesis before treatment and did not show any improvement. One patient with a glomus-type arteriovenous malformation showed transient neurological deterioration just after embolization with the Tracker-10 to occlude a lesion fed by the posterior spinal artery, because the Ivalon particles migrated into the anterior spinal artery via the anterior spinal canal artery. In one patient with a juvenile arteriovenous malformation, the Tracker-18 catheter perforated the radiculomedullary artery originating from the right vertebral artery, and subarachnoid hemorrhage occurred. However, the Tracker-10 could later successfully occlude the arteriovenous malformation. The rates of recanalization and appearance of the new feeding vessels were 4/8 (50.0%) and 2/8 (25%), respectively.

Ischemic myelopathy: a review of spinal vasculature and related clinical syndromes

This article provides a comprehensive review of spinal vascular anatomy (arterial and venous) and clinical syndromes that result from the disruption of blood flow to or from the spinal cord. Blood is supplied to the spinal cord through three longitudinal channels: one anterior and two posterior spinal arteries. These vessels, which originate as branches of the vertebral arteries and run caudally along the spinal cord, are augmented by a variable number of medullary arteries. A vascular ring, or vasa coronae, surrounds the cord and connects these longitudinal channels. Central arteries from the anterior spinal artery and penetrating vessels from the vasa coronae provide blood directly to the cord. Venous flow from the spinal cord is also accomplished through a system of anterior and posterior spinal vessels draining through a variable number of medullary veins and an extensive valveless vertebral venous plexus. The disruption of blood flow to or from the spinal cord can result in infarction, with permanent neurologic loss and physical impairment. The clinical presentation in cases of ischemic myelopathy can be variable. Discrete syndromes based on the occlusion of specific vessels are reported and include venous infarction, anterior and posterior spinal artery syndrome, and central infarction.

Spinal cord injury syndrome with motor sparing in the absence of all sensation

This paper describes the anatomic basis for the unusual presentation in a spinal cord injured subject of preservation of motor power in the absence of all sensation. The patient was examined at four hours, and daily thereafter, after a motorcycle accident in which he was thrown over the handle bars. He had trace ankle dorsi and plantar flexors, but light touch, pin, position, and vibratory sensation were absent below the level of C4 bilaterally. There was no physical evidence to differentiate whether he suffered a flexion or extension injury. Cervical spine films showed no evidence of fracture or dislocation, but anterior and posterior osteophytes involving C3 to C4, C4 to C5, and C5 to C6 were present. Magnetic resonance imaging showed evidence of cervical cord edema at C3 to C4 with possible hemorrhage and severe spinal stenosis at C3 to C4 and C4 to C5. This patient received a compression injury with resulting classic anterior spinal artery syndrome. Because of his spinal stenosis with a decreased anterior-posterior (AP) diameter of the canal, the posterior circulation was also compromised. The extensive pial anastomotic network provided relative sparing of the most peripheral components of the lateral corticospinal tracts. This case report demonstrates a unique clinical picture that cannot be anatomically classified by current American Spinal Injury Association (ASIA) standards as central cord syndrome. It can be explained by the lamination of the ascending and descending tracts in relation to the vascular supply of the cervical cord in conjunction with the narrowing of the AP diameter of the canal due to spinal stenosis.

The arterial supply of the human spinal cord: a new approach to the arteria radicularis magna of Adamkiewicz

The arteria radicularis magna (Adamkiewicz's artery) was studied in 30 human spinal cords after arterial injection. The artery was present in all cases, between T8 and L2, and was identified by its diameter and position. The arteria radicularis magna was the main blood supply to the lowest region of the spinal cord. In one out of three cases it accompanied the ventral root at T9, and in 80% of the cases studied it was found on the left side. The arteria radicularis magna had a posterior component in 63% of the cases. We did not observe specific radiculo-medullary arteries in the conus medullaris region.

Vascular permeability of spinal nerve roots. A study in the rat with Evans blue and lanthanum as tracers

The permeability of blood vessels in rat spinal nerve roots was investigated with Evans blue-albumin as an in vivo macromolecular tracer and lanthanum nitrate as an electron microscopic ionic marker added to a fixative. Rats injected intravenously with Evans blue, showed macroscopic distinct staining of dorsal root ganglia, whereas spinal nerve roots remained unstained. Fluorescence microscopy, however, revealed clear extravascular fluorescence both in ventral and dorsal roots 2 or 18 h after tracer administration. Two different types of blood vessels exists in spinal nerve roots; large extrinsic (radicular) in the root sheath and minute intrinsic vessels in the parenchyma. Lanthanum added to a fixative, perfused through the vessels was detected in the lumen of both types of vessels, usually adhering to the luminal plasma membrane and in many invaginations from that membrane. Lanthanum also entered the clefts between endothelial cells but was always stopped at the junctions which are, thus, of the tight type. Diffuse penetration of the compound into the cytoplasm was seen in one endothelial cell, but no fenestrations were detected. Junctions between the endothelial cells of vessels in rat spinal nerve roots are impermeable to lanthanum and most likely also to other large molecular substances like albumin. Thus, probable routes for serum albumin to enter the nerve roots, where it normally is present, must be either by centripetal extracellular diffusion from the ganglia and the peripheral nerve or by vascular leakage in the roots, caused by for instance pinocytosis across endothelial cells.

Response of spinal cord blood flow and motor and sensory evoked potentials to aortic ligation

To produce spinal cord ischemia in the lamb, ligation of the thoracic aorta was performed for 15, 30, and 45 minutes in three animals each. Spinal cord blood flow and motor and sensory evoked potentials were measured before, during, and after aortic ligation. Ischemia with a blood flow of zero during ligation was encountered in the thoracic and lumbar cords, followed by hyperemia upon release of the ligature. Both somatosensory and motor evoked potentials were obliterated during aortic ligation and gradually recovered following resumption of flow. Motor and sensory evoked potentials behaved similarly to high aortic ligation.

Blood supply of spinal nerve roots. An experimental study in the rat

The blood supply of rat spinal nerve roots was investigated using a variety of methods, including preparation of vascular casts with Microfil, alkaline phosphatase histochemistry and Epon embedding for light and electron microscopy. Dorsal and ventral roots were sampled and portions from the spinal cord, dorsal root ganglia and peripheral nerve were taken for comparison. There were two different types of vessels in the roots; the large extrinsic (radicular) and the minute intrinsic vessels of the nerve root parenchyma. The radicular vessels follow a straight course along the longitudinal axis of both ventral and dorsal roots. Their diameter appears to vary in different topographical regions. They are united with the longitudinal spinal cord arteries and are a major source of arterial supply to the spinal cord. There are also many small communicants with the intrinsic root vasculature. The radicular vessels are located in the root sheath and are surrounded by cells and collagen fibers forming this sheath. The intrinsic vessels of the spinal roots form a plexus of minute vessels, chiefly capillaries. Most of them are longitudinally arranged along the roots but there are also many loops and twisted portions. There are many direct connections to neighbouring vascular networks. The microvessels are surrounded by a basement lamina and wide, collagen containing extracellular spaces. The intrinsic vascularization of the roots is similar to that in the endoneurium of peripheral nerves, i.e., chiefly a plexus of minute vessels. Many direct communicants exist between these intrinsic vessels and blood vessels in the spinal cord parenchyma, ganglia and nerve.

Spinal cord infarction

Spinal cord infarction occurs infrequently and may have diverse causes. It is necessary to establish whether an intrinsic or extrinsic lesion is responsible for the impaired cord function. Although therapy is limited at this time, the long-term prognosis is not necessarily unfavorable.

Analysis of the histopathology of radiation myelopathy

An analysis of published histopathology reports of patients with radiation myelopathy was performed. Radiation lesions in the spinal cord were classified as primarily white matter parenchymal lesions (type 1), primarily vascular lesions (type 2), or a combination of vascular and white matter lesions (type 3). The presence or absence of a mononuclear inflammatory reaction was also noted. Type 1 and type 3 lesions had comparable latent periods, both significantly shorter than those observed for type 2 lesions. The anatomical level of the irradiation did not appear to influence the type of lesion. Inflammatory reaction was observed with greater frequency in type 3 lesions. For all types of lesions, the average latent periods in patients with inflammatory reactions were shorter than in those without inflammation. In the cases in which disease status was evaluated, 70% of the patients were free of disease or had no evidence of recurrence at autopsy.

Traumatic infarction of the spinal cord in children

Infarction of the spinal cord in childhood is rarely due to trauma. During a 15-year period (1971 to 1985), eight children were admitted to The Hospital for Sick Children, Toronto, with a diagnosis of traumatic infarction of the spinal cord. All of these patients had delayed onset of neurological signs varying between 2 hours and 4 days after their initial trauma. No bone abnormalities were seen on plain spine x-ray films. Myelography was carried out in seven of these children and found to be normal in all seven. Six patients who were paraplegic at the time of admission remained permanently paraplegic, but two with incomplete cord signs did show some improvement.

Late paraplegia as a consequence of intraaortic balloon pump support

There have been several reports of paraplegia after intraaortic balloon counterpulsation in the surgical literature. In each instance, the paraplegia occurred during the period of counterpulsation support. We describe a patient in whom late paraplegia occurred three days after the removal of an intraaortic balloon catheter.

Case report of infarction in the region of the posterior spinal arteries

Spinal cord infarction in the region of the posterior spinal arteries is reported in a 62-year-old woman. The softening was restricted to the lumbosacral region involving two segments. Sectioning the affected and adjacent segments serially no occlusion was found in the posterior spinal arteries. Besides the circumscribed infarction the microscopic picture of the spinal cord was characteristic of vascular myelopathy. The underlying disorders of the previously reported cases and the predisposing factors contributing to the development of infarction are discussed. It is concluded that an insufficient anastomotic network plays the essential role in the pathogenesis of the spinal cord infarction.

Natural history of ascending thrombosis of the abdominal aorta

During 1980, 30 patients underwent successful operations for ascending thrombosis of the abdominal aorta in its three forms: low (below the inferior mesenteric artery, 11 patients); middle (above the inferior mesenteric artery, 6 patients); and high (at the level of the renal arteries, 13 patients). An angiogram that reveals high ascending thrombosis of the abdominal aorta is paradoxically more favorable than one that reveals middle or low ascending thrombosis of the abdominal aorta. In fact, the patient with a juxtarenal thrombosis has already overcome two of the three phases that constitute the critical moments of potential failure of the collateral circulation. Progressive ascending thrombosis with a poor prognosis and a rapidly downward course can cause acute ischemia with paraplegia of the legs and intestinal infarction. Most patients die suddenly in the emergency or intensive care unit from paraplegia, acute abdomen, or anuria; the latter is due to further progressive thrombosis with obstruction of the orifice of the renal arteries. On the basis of the angiogram only (apart from subjective symptoms), ascending thrombosis of the abdominal aorta constitutes an absolute indication for surgical treatment.

Arterial circulation of the spinal cord and brain in the Monodontidae (order Cetacea)

In this paper we document retial supply of the spinal cord and describe the arterial vascular pattern of the brain in the whale family Monodontidae. Observations are based on gross dissections of four brains, two each of Monodon monoceros and Delphinapterus leucas, and one spinal cord from M. monoceros. Vessels of the spinal cord arise from extradural retia in the neural canal. Arteries originating from the retia penetrate the dura between successive spinal roots (mainly ventral) and not in association with them, unlike radicular arteries of other mammals. Also, these vessels are uniformly distributed and contribute equally to a plexus surrounding the cord. An A. radicularis magna is not present, and neither are distinct anterior or posterior spinal arteries. Circulation to the brain is effected by two pairs of arteries originating from intracranial retia. The rostral pair supplies most of the forebrain (prosencephalon), whereas the more caudal pair supplies mainly the midbrain (mesencephalon) and hindbrain (rhombencephalon). The circulatory pattern is characterized by 1) complete independence of anterior cerebral arteries (no anastomoses); 2) extensive cortical supply by the anterior choroidal arteries; 3) absence of subdural communicating vessels between rostral and caudal trunks; 4) union of caudal trunks to form a small basilar artery; and 5) absence of vertebral arteries and hence of a vertebral basilar system. There are some obvious differences between subdural arteries in the Monodontidae and those in other mammals; however, their general patterns of distribution are similar, and we suggest that most of the vessels, at least in the cranium, are homologous.

Paraplegia following balloon assistance after cardiac surgery

Contrapulsation by means of an intra-aortic balloon is an effective and well-known therapeutic measure in the postoperative period after cardiac surgery, mainly when interrupting cardiopulmonary bypass in left ventricular failure situation (3, 4). We present the case of a patient who developed paraplegia 38 hours after surgery, which was attributed to contrapulsation.

Spinal cord vascularity. IV. The spinal cord arteries in the rat

The present investigation has shown that the anatomy of the spinal cord arteries in the rat and in man is closely related but not identical. The main differences are: (1) The poor supply of radicular arteries to the lower cervical and upper thoracic segments of the cord is more marked in the rat, (2) the great ventral radicular artery of Adamkiewicz is less subjected to variations in position in the rat, (3) penetrating branches from the pial arterial plexus are absent in the rat, (4) surface anastomoses between the ventral and the dorsal spinal arteries do not occur in the rat except occasionally at the lower end of the cord. Intramedullary arterial anastomoses in the lumbosacral cord of the rat seems to be species specific.

Spinal cord vascularity. III. The spinal cord arteries in man

The arterial supply of the human spinal cord was investigated in detail using microangiography and binocular microscopy after the specimens had been made transparent. (1) The arterial tributaries to the spinal cord were found to come from the anterior radicular arteries in a total number varying from 3 to 15, and from posterior radicular arteries numbering 14 to 25. The location of the great anterior radicular artery varied from Th8 to L3. This artery was most often the only ventral feeder to the lower cord. (2) The surface arteries of the spinal cord were mainly derived from the posterior longitudinal arteries with only tiny anastomoses from the anterior spinal artery. The pial artery plexus was best developed over the posterior surface of the cord, particularly at levels of the enlargements. (3) The intramedullary central part us supplied by the anterior spinal artery and a peripheral part mainly from the posterior longitudinal arteries. Anastomotic connections between the two systems or between individual arteries within the two systems could not be observed.

Spinal cord vascularity. I. Extraspinal sources of spinal cord arteries in man

The arrangement of extraspinal sources of the spinal cord arterial supply in man is more complicated than previously described, especially with regard to the origin and branching of the aortic segmental arteries. The fact that other arteries in the neck than the vertebral artery, such as the costo-cervical trunk and the ascending cervical artery may contribute to the supply of the cervical cord is confirmed, and also the occurrence of two or more spinal branches from different sources entering the same intervertebral foramen. Frequent occurrence of two or more segmental arteries arising from a common stem and variations in the branching of the subcostal arteries were found; their functional significance on the spinal cord circulation is not known. The fact that no significant anterior root artery was ever seen at the level of the vascular anomaly suggests that the anomaly is of no clinical importance. Nevertheless, obstruction of a common stem entail the risk of spinal cord infarction due to involvement of an important posterior root artery. On the other hand, the spinal cord seems to be fairly well protected against ischaemic injury following limited interference with the extraspinal arteries due to a profuse supply of intra- and extraspinal collaterals.

Cauda equina pseudoclaudication syndrome

Intermittent claudication is known as a specific symptom in patients with chronic occlusive arterial lesions. Clinically it is important that neurogenic intermittent pseudo-claudication should be differentiated from true intermittent claudication. Nevertheless confusion still exists in differential diagnosis between these two entities. This paper deals with general review of intermittent pseudo-claudication and a particular emphasis is placed on the different concepts of the pathophysiology and the differential diagnosis from the standpoint of vascular surgery. Recently one case of the neurogenic intermittent pseudo-claudication was encountered and presented in this paper.

Electromyographic studies in a case of foramen magnum meningioma

Atrophy of muscles innervated by the lower cervical cord is a well-known feature in patients with foramen magnum tumours. Electromyographic evidence of denervation in the atrophic muscles is presented. The significance and possible mechanisms are reviewed and discussed.

Histopathology of transistory traumatic paraplegia in the monkey

✓ The microscopic appearance of the primate spinal cord within a 4-hour interval following the delivery of a direct force sufficient to produce a transitory paraplegia was investigated by light microscopy. The resulting hemorrhagic lesion involved primarily the central gray matter and was attributed to the direct effect of the trauma on the vessels in the gray matter with a consequent impairment of blood supply to the injured area. Chromatolysis, vacuolation, and alterations in cytoplasmic density and stainability were observed within the neurons. The edematous changes in the white matter, which were more marked in the internal layers relative to the external layers, appeared minimal and explain in part why the paraplegia was transient.

Paraplegia following thoracolumbar sympathectomy. Case report

✓ A case is presented in which a bilateral thoracolumbar sympathectomy and splanchnicectomy were followed by permanent paraplegia below T-10. The hypothesis is presented that coagulation of a bleeding intercostal vessel during surgery led to a propagating thrombus which involved, successively, the intercostal artery, a segmental medullary vessel, and the anterior spinal artery with resulting spinal cord infarction. Other possible mechanisms are mentioned. Several technical suggestions are offered with regard to prevention of this complication.

Transthoracic ligation of intercostal arteries for arteriovenous malformations of the spinal cord

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The anterior spinal artery syndrome--a complication of abdominal aortic surgery: report of five cases and review of the literature

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Ischaemic lacunae in the spinal cord of arteriosclerotic subjects

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