Zalewski NL, et al. - Researchers assessed the characteristics of spontaneous spinal cord infarction (SCI) and proposed diagnostic criteria in this study. Findings demonstrated that a correct diagnosis of SCI, as well as an improved future care for patients, may be achieved with the help of the validated diagnostic criteria proposed in this study.

Methods

• Using an institution-based search tool, researchers identified patients evaluated at the Mayo Clinic (Rochester, MN; January 1997-December 2017) with spontaneous SCI.
• They assessed 133 adults with spontaneous SCI and 280 control participants.
• Descriptive analysis of SCI was used to propose diagnostic criteria, which were then validated.

Results

• Participants had a median (interquartile range) age of 60 (52-69) years at presentation, and vascular risk factors were present in 101 (76%).
• Raid onset of severe deficits reaching nadir within 12 hours was typical (102 [77%]); some had a stuttering decline (31 [23%]).
• Sensory loss was evident in 126 patients (95%), selectively affecting pain/temperature in 49 (39%).
• Thirty patients (24%) had normal initial magnetic resonance imaging (MRI) spine results.
• Owl eyes (82 [65%]) and pencil-like hyperintensity (50 [40%]) were documented as characteristic MRI T2-hyperintense patterns; gadolinium enhancement (37 of 96 [39%]) was often linear and located in the anterior gray matter.
• Diffusion-weighted imaging/apparent diffusion coefficient restriction (19/29 [67%]), adjacent dissection/occlusion (16/82 [20%]), and vertebral body infarction (11 [9%]) comprised confirmatory MRI findings.
• Seven of 89 patients (8%) were found to have mild inflammation in cerebrospinal fluid.
• Diagnostic criteria were proposed for definite, probable, and possible SCI of periprocedural and spontaneous onset.
• In the validation cohort (n=280), criteria for possible SCI were met by nine patients (3%), and none met criteria for probable SCI.