Spinal Stroke: Symptoms, Types, Causes and Treatment

Spinal stroke is a rare but serious medical emergency that affects the spinal cord, disrupting its ability to transmit signals between the brain and the rest of the body. While most people are familiar with cerebral (brain) strokes, spinal strokes are less recognized but can be equally devastating. This comprehensive guide explores the key aspects of spinal stroke—including its symptoms, types, causes, and treatment options—drawing from the latest research and clinical insights.

Symptoms of Spinal Stroke

Spinal stroke can strike suddenly, often catching patients and clinicians off guard. Recognizing the symptoms quickly is crucial for prompt intervention and better outcomes. Unlike brain strokes, spinal strokes often present with unique patterns of neurological deficits that reflect the damaged area of the spinal cord.

Symptom	Description	Onset	Source
Paralysis	Sudden loss of motor function	Rapid	1 5
Sensory Loss	Numbness, tingling, or anesthesia	Acute	1 5
Pain	Severe back or radiating pain	May precede	1 5
Autonomic Dysfunction	Bladder/bowel issues	Variable	1

Table 1: Key Symptoms

Sudden Paralysis or Weakness

A hallmark of spinal stroke is the abrupt onset of paralysis or profound muscle weakness, typically affecting both legs (paraplegia) or, less commonly, all four limbs (quadriplegia) depending on the level of spinal cord involvement. This sudden loss of movement can be terrifying and disabling, often developing within minutes to hours after the initial insult 1 5.

Sensory Disturbances

Many patients experience a rapid loss of sensation below the level of the lesion. This sensory change can range from tingling and numbness to complete anesthesia. Some individuals may notice a distinct sensory level on their torso where normal sensation abruptly stops. Loss of pain and temperature sensation is typical, while proprioception (sense of body position) and vibration sense may be preserved in certain types of spinal strokes 5.

Severe Back or Radiating Pain

Unlike cerebral strokes, spinal strokes are often preceded or accompanied by severe back pain, sometimes radiating between the shoulder blades or down into the legs. This pain can serve as an early warning sign, especially in cases termed "biphasic spinal strokes," where transient sensory deficits and radiating pain occur before more permanent neurological loss 1.

Autonomic Dysfunction

Disruption of spinal cord pathways can also affect autonomic functions, leading to issues such as urinary retention or incontinence, bowel dysfunction, and, in severe cases, blood pressure instability. These symptoms add to the complexity and urgency of spinal stroke diagnosis and management 1.

Types of Spinal Stroke

Spinal strokes can be classified based on their underlying mechanism and the region of the spinal cord they affect. This classification helps guide diagnosis, prognosis, and treatment strategies.

Type	Mechanism	Common Location	Source
Infarction	Blockage of blood flow	Cervical, Thoracolumbar	1 5
Hemorrhagic	Bleeding within cord	Variable	1
Anterior Spinal Artery Syndrome	Ischemia to anterior cord	Mid/Lower spine	5
Biphasic	Transient then permanent deficits	Often cervical	1

Table 2: Types of Spinal Stroke

Spinal Cord Infarction

Spinal cord infarction is the most common type of spinal stroke, resulting from interrupted blood supply—usually due to blockage or narrowing of arteries serving the spinal cord. It accounts for approximately 0.3–1% of all strokes, making it a rare condition 1. Infarctions are often classified by their location:

• Upper (Cervical) Infarctions: Typically involve the neck region and may lead to quadriplegia.
• Lower (Thoracolumbar) Infarctions: Affect the lower back and are more likely to cause paraplegia 1.

Hemorrhagic Spinal Stroke

Less common than infarction, hemorrhagic strokes involve bleeding within or around the spinal cord, leading to pressure and direct damage to spinal tissues. Causes can include vascular malformations, trauma, or underlying bleeding disorders 1.

Anterior Spinal Artery Syndrome

This specific syndrome arises when the anterior spinal artery—supplying the front two-thirds of the spinal cord—becomes blocked, often resulting in a characteristic pattern of neurological deficits: paralysis and loss of pain and temperature sensation below the lesion, but preservation of vibration and proprioception 5. Prompt recognition is critical, as specific interventions may be possible in some cases.

Biphasic Spinal Stroke

About one-fifth of cases may present as "biphasic" strokes, where a transient episode of radiating pain and sensory loss precedes more significant and permanent neurological deficits. Recognizing this pattern is essential for early intervention 1.

Causes of Spinal Stroke

Understanding the root causes of spinal stroke can aid in prevention and targeted treatment. While some risk factors overlap with cerebral stroke, others are unique to the spinal cord.

Cause	Description	Risk Factors	Source
Arterial Occlusion	Blocked blood flow (e.g., atherosclerosis, embolism)	Hypertension, diabetes	1 5
Vascular Malformations	Abnormal blood vessels (e.g., AVMs)	Congenital	1
Trauma	Direct injury to spinal vessels	Accidents, surgery	1
Systemic Hypotension	Drop in blood pressure	Cardiac arrest, shock	1

Table 3: Main Causes

Arterial Occlusion

The leading cause of spinal cord infarction is blockage of the arteries supplying the cord. This can happen due to:

• Atherosclerosis: Build-up of plaque narrows the arteries.
• Embolism: Blood clots from elsewhere in the body become lodged in spinal vessels.
• Small Vessel Disease: Especially in individuals with hypertension or diabetes 1 5.

Vascular Malformations

Congenital abnormalities like arteriovenous malformations (AVMs) can predispose individuals to bleeding or infarction of the spinal cord. These rare conditions may remain silent until a catastrophic event occurs 1.

Trauma

Major trauma, including spinal fractures or surgical complications, can injure the arteries or veins serving the spinal cord, resulting in either infarction or hemorrhage 1.

Systemic Hypotension

A significant drop in blood pressure from cardiac arrest, severe blood loss, or shock can deprive the spinal cord of oxygen-rich blood, particularly in its vulnerable watershed zones 1.

Other Contributing Factors

While traditional risk factors for brain stroke—such as advanced age, smoking, and high cholesterol—are less strongly linked to spinal stroke, conditions like hypertension and diabetes can increase severity and influence outcomes 1. Interestingly, spinal cord infarction patients tend to be younger and more often female compared to those with cerebral infarction 1.

Treatment of Spinal Stroke

Managing spinal stroke requires rapid diagnosis, targeted interventions, and comprehensive rehabilitation to maximize functional recovery. While some treatments are borrowed from cerebral stroke management, others are unique to spinal cord injury.

Treatment	Approach/Modality	Goal/Effect	Source
Thrombolysis	Intra-arterial t-PA	Restore blood flow	5
Rehabilitation	PT, OT, electrical stimulation	Improve motor/sensory function	2 3 4
Chiropractic	Spinal adjustments + PT	Enhance motor function	6
Risk Factor Control	Manage hypertension, diabetes	Prevent recurrence, improve outcome	1

Table 4: Major Treatments

Acute Interventions

Thrombolytic Therapy

In carefully selected cases of spinal cord infarction—especially those caused by anterior spinal artery occlusion—direct intra-arterial thrombolytic therapy (such as t-PA administration) has been shown to rapidly restore blood flow and improve neurological outcomes. However, this treatment remains rare and should be performed in specialized centers 5.

Risk Factor Management

Addressing underlying conditions like hypertension and diabetes is crucial, especially during the acute phase. Aggressive management of these risk factors can help limit the extent of injury and optimize recovery 1.

Rehabilitation

Physical and Occupational Therapy

Early and intensive rehabilitation with physical and occupational therapy is essential for restoring lost function, improving mobility, and maximizing independence. Task-specific interventions and tailored therapy plans are recommended, considering the unique needs and timing post-injury 4.

Electrical Stimulation

Functional electrical stimulation (FES) and sensory input therapies like transcutaneous electrical nerve stimulation (TENS) can significantly enhance motor recovery when combined with conventional rehabilitation. FES can help retrain muscles for tasks such as walking, grasping, and standing, while sensory stimulation promotes neural plasticity and functional gains, particularly in the early and chronic phases after a stroke or spinal injury 2 3.

Chiropractic Adjustments

Emerging research suggests that chiropractic spinal adjustments, when combined with physical therapy, may produce short-term improvements in motor function for people with chronic spinal stroke. While the long-term benefits and optimal protocols are still being investigated, these interventions may complement traditional rehabilitation approaches 6.

Long-Term Management

• Pain Management: Chronic pain is common after spinal stroke and may require medication, physical modalities, and psychological support 1.
• Emotional and Social Support: Emotional well-being is generally higher in spinal stroke survivors compared to brain stroke patients, but ongoing support can improve quality of life and facilitate reintegration, including higher rates of return to work 1.
• Prevention of Complications: Preventing pressure sores, urinary tract infections, and spasticity is key to long-term health 4.

Conclusion

Spinal stroke, though rare, poses significant challenges due to its sudden onset and potential for severe disability. Early recognition and intervention are vital for optimal outcomes. Advances in rehabilitation, electrical stimulation, and even targeted thrombolytic therapies offer hope for improved recovery and quality of life.

Key Takeaways:

• Spinal stroke is a rare event, most often caused by arterial blockage, trauma, or vascular malformations 1 5.
• Symptoms often include sudden paralysis, sensory loss, severe back pain, and autonomic dysfunction 1 5.
• Types of spinal stroke are classified by mechanism (infarction, hemorrhage) and region (cervical, thoracolumbar), with anterior spinal artery syndrome being a notable subtype 1 5.
• Prompt management with thrombolysis (in select cases), risk factor control, and comprehensive rehabilitation—including electrical stimulation and innovative therapies—can enhance recovery 1 2 3 4 5 6.
• Emotional well-being and return to daily life are achievable for many spinal stroke survivors, highlighting the importance of holistic, patient-centered care 1.

By staying alert to the symptoms and understanding the evolving landscape of treatment, both clinicians and patients can contribute to better outcomes in this challenging neurological condition.