Syndrome of the Anterior Spinal Artery

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Abstract
A study of 6 cases of anterior spinal artery syndrome defined typical clinical chis sudden or rapid with girdle-like pain followed by loss of perception to pain, touch and temp., and motor paralysis below the level of the lesion in the spinal cord. Motor paralysis at the level of the lesion is of the lower motor neuron type, but of the upper motor neuron type below. A disturbance of bladder function occurred in all cases with early retention, and in severe cases an uninhibited neurogenic bladder was a residual. Voluntary bladder control was reestablished in a few weeks in most cases. The lesion occurred in the lower cervical spinal cord in two cases and in the mid-thoracic and lower thoracic cord in the remainder. Syphilitic arteritis was the etiologic factor in two cases, arteriosclerosis in three cases, and infection in one case. Pain is the initial symptom in most cases and occurs at a level just above the height of the lesion in the spinal cord or at the level just below the thrombotic zone. Paralysis varies in type depending on the height of the lesion. If the cervical or lumbar cord levels are involved, a lower motor neurone paralysis is present in the corresponding limbs. A lesion in the thoracic spinal segments is followed by a spastic paraplegia in the lower extremities. Except in the highest cervical lesions the sensory changes are dissociated; pain, touch, and temp, being abolished below the level of the lesion with preservation of vibratory and position sense. Unless there is grossly bloody spinal fluid with or without spinal subarachnoid block, central hemorrhage into the spinal cord cannot be differentiated from anterior spinal artery thrombosis. The prognosis has been improved by modern treatment of the bladder disturbance and early physical rehabilitation procedures. These include continuous catheter or tidal drainage, the use of bladder irrigations and antibiotic drugs for urinary infection. Passive and active exercises and ambulation as early as possible are stressed.

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