Arteria spinalis anterior syndrome is a condition caused by a reduction in blood flow in the so-called anterior spinal artery. As a result of this reduced blood flow, a typical set of symptoms develops, which is collectively referred to as spinal anterior artery syndrome. Basically, the arteria spinalis anterior syndrome is a disease that affects only a few people.
Arterial spinalis anterior syndrome
Arteria spinalis anterior syndrome is also abbreviated spinalis anterior syndrome by some medical professionals. The disease is characterized by a disturbance of blood flow in a specific artery called the anterior spinal artery. The disease develops acutely in the majority of cases. However, a subacute course is also possible. In most cases, spinal anterior artery syndrome develops without prior signs. The condition generally occurs relatively rarely.
Causes
The causes for the development of spinal artery anterior syndrome are varied and numerous. In some patients, microangiopathy leads to the condition, which results primarily in the setting of diabetes mellitus. Vasculitis is also a potential cause of spinal artery anterior syndrome. Finally, a so-called AV fistula possibly causes the development of the typical symptoms. Furthermore, in some cases the arteria spinalis anterior syndrome is caused by damage to the aorta. Responsible for this is, for example, an aneurysm in the course of the aorta. In addition, spinal anterior artery syndrome sometimes develops following surgical procedures. Mechanical crushing of the anterior spinal artery also poses a risk. In some circumstances, a herniated disc compresses the artery. Tumors have a similar effect, taking up more space and displacing surrounding tissue. Conditional on reduced blood flow to the affected artery, damage occurs to the lateral and anterior cords in the medulla of the back.
Symptoms, complaints, and signs
The affected patient suffers from various complaints as a result of spinal artery anterior syndrome. For example, paraparesis usually develops as part of the disease. In addition, the rectum and bladder are usually impaired in their functioning. In addition, disorders of sensitivity of a dissociated nature occur in numerous diseased individuals. In most cases, the perception of pain and different temperatures does not function as usual. Touch, on the other hand, is usually perceived and attributed without problems. The arteria-spinalis-anterior syndrome often causes pain and leads to band-like paresthesias. Patients suffering from the arteria spinalis anterior syndrome suffer from acute symptoms in the majority of cases. The syndrome often starts with a so-called spinal shock. This condition lasts for several weeks to several months. The shock is accompanied by paraparesis, which is usually located under the damaged area.
Diagnosis and course
Diagnosis of spinal artery anterior syndrome is made with the aid of various investigative procedures. At the beginning of the diagnosis, the patient participates in the anamnesis, which the physician conducts with him. During this discussion, the patient describes his or her individual symptoms. He also discusses past illnesses and describes his lifestyle. The family history plays a subordinate role, but must also be taken into account. The attending physician then applies a selection of clinical examinations. Imaging procedures are of great importance. In relation to the spinal artery anterior syndrome, CT or MRI examinations are often performed. In some cases, angiography is also obtained. This is especially true for patients in whom an AV fistula is suspected. The imaging techniques usually make the disturbances of blood flow in the artery clearly visible. In this way, the disease can be diagnosed with relative certainty. The CT scan is used in particular to detect potential tumors or herniated discs. In connection with the diagnosis, the physician also performs a differential diagnosis to rule out other diseases with similar complaints.Here, the doctor usually checks whether multiple sclerosis, myelitis or the so-called Leriche syndrome are present. The disease must also be differentiated from funicular myelosis and mantle edge syndrome, because these diseases cause similar symptoms in many cases.
Complications
Spinal artery anterior syndrome occurs rather rarely. This is a reduction in blood flow that occurs in the anterior spinal artery. Usually, this occurs spontaneously without further physical notice. At times, an unnoticed disease or inflammation of the small blood vessels is often present in combination with diabetes mellitus. On the other hand, arteriovenous fistula, spinal contusion due to a fall or accident, tumor involvement, and herniated discs are more likely to be noticed. Likewise, an aneurysm formed directly at the aorta can lead to the onset of the syndrome. Sometimes the arteria spinalis anterior syndrome occurs as a complication of an operation. Depending on the origin of the syndrome, its course can be extremely complicated for the affected person. Due to the reduced blood supply to the spinal cord aorta, it can be permanently damaged. Irreversible sensory disturbances, a lifelong reduced bladder and rectal function and, in the worst case, an incomplete bilateral paralysis become apparent. Even with early symptom treatment, the patient requires several months of convalescence. If necessary, anticoagulants as well as corticosteroids are prescribed and a urinary catheter is placed. The medications may cause side effects as a further complication. Occupational, physical and psychotherapeutic measures provide holistic support for the affected person. If the spinal cord aorta has been crushed in an accident or if there is tumor involvement, surgical intervention must be considered.
When should you see a doctor?
In the case of spinal artery anterior syndrome, a physician should be consulted especially when the complaints and symptoms of this syndrome appear. This can directly prevent further complications and discomfort if early treatment is initiated. As a rule, a doctor must be consulted when the affected person suffers from disturbances in sensitivity or sudden paralysis. These can affect different regions of the body. Furthermore, discomfort in the bladder is a typical symptom of spinal artery anterior syndrome and must be examined by a physician. It is not uncommon for the perception of pain to be affected by spinal artery anterior syndrome. Therefore, if this complaint or misperception of temperatures occurs, medical treatment must likewise be provided. In case of acute and severe symptoms, the affected person can also go directly to a hospital. As a rule, the spinal artery anterior syndrome can be diagnosed by a general practitioner. The treatment of this syndrome is eventually carried out by various specialists. Usually, most of the symptoms of arterial spinal anterior syndrome can be successfully limited.
Treatment and therapy
Treatment of spinal artery anterior syndrome addresses several issues. First, prophylactic measures are taken with regard to thrombosis. A bladder catheter is also required in some patients. For support, those suffering from spinal artery anterior syndrome often receive occupational or physical therapy. If spinal artery anterior syndrome is the result of a primary underlying disease, coordinated measures of treatment are necessary. The prognosis of the arterial spinalis anterior syndrome does not look very positive in numerous cases. This is because the medulla of the spinal cord is only able to withstand ischemia for a short time. Further complaints such as disturbances in the function of the bladder, rectum and sensibility are in numerous cases no longer reversible. Here, only symptomatic therapeutic approaches help to alleviate the discomfort for the individual. If the anterior spinal artery is locally squeezed, surgical interventions are used immediately, for example in the case of tumors or herniated discs. To prevent thrombosis, patients usually receive the active ingredient heparin. Corticosteroids reduce inflammatory processes. Measures are also required to prevent pressure sores, as the risk of this complication is increased in the context of spinal artery anterior syndrome.
Outlook and prognosis
The prognosis of spinal artery anterior syndrome is individual and depends on several factors. The least favorable outlook for recovery is when the circulatory disorder is discovered very late or when hemorrhage has already occurred. In these cases, various complaints have occurred, which causes a permanent impairment of various physical functions. If bladder or bowel activity have been permanently disrupted, irreversible damage is usually present. A contusion of the spinal cord is also to be classified as unfavorable. Depending on the severity of the crushed area, there may be lifelong consequences. Therapeutic measures aim to alleviate existing symptoms. However, a cure is not possible. If the area is slightly damaged and immediate intensive medical treatment is given, the probability of alleviating symptoms increases. Another unfavorable course is given in the case of tumor involvement. The prognosis prospects in the case of the arteria spinalis anterior syndrome increase if the circulatory disturbance is diagnosed and treated at an early stage. If the circulatory disorder is detected at a very early stage, there is a good chance of recovery. If it develops due to an acute situation, such as an accident or fall, the chances of recovery decrease. The circulatory disorder increases the risk of thrombosis. This secondary disease can be treated well with today’s possibilities if it is treated early. Nevertheless, there is a risk of dying from a thrombus.
Prevention
Measures to prevent spinal artery anterior syndrome are based particularly on the potential causes capable of triggering the disease.
Follow-up
In spinal artery anterior syndrome, the patient has very limited options for follow-up care. The affected person is primarily dependent on direct and medical treatment by a physician, since self-healing cannot occur in this disease. Furthermore, early diagnosis also has a positive effect on the further course of the disease. The affected persons are also dependent on various physiotherapies due to the arterial spinalis anterior syndrome. In many cases, the exercises from these therapies can also be performed in the patient’s own home, which can also accelerate the healing process. When taking medication, it should be noted that the affected person should always follow the doctor’s instructions. If there is any uncertainty, a doctor should always be consulted. Furthermore, a healthy lifestyle with a healthy diet also generally has a positive effect on the course of spinal artery anterior syndrome and can limit further complications. The support of the affected person by his own family or by friends is also very important in order to limit psychological complaints or upsets. Contact with other sufferers of the syndrome can be useful in this regard, as it can lead to an exchange of information.
What you can do yourself
Often, the symptoms of the rarely occurring arterial spinal anterior syndrome set in without warning. The diagnosis of a spinal cord infarction with all the resulting symptoms initially triggers horror and bewilderment in most of those affected. However, even patients who are threatened with reduced blood flow to the anterior spinal cord artery as a foreseeable complication of surgery react with shock when they are actually confronted with partial or complete paraplegia and the prospect of a life in a wheelchair. In this situation, it is very important that the patient does not lose the courage to face life. He needs motivation, a sense of achievement and effective pain therapy to avoid falling into depression. With a nerve and muscle stimulator that works with stimulation current, neuropathic pain can be relieved independently of medical measures. In addition to pain therapy and medically appropriate physical therapy, it is recommended that sufferers begin gentle strength training as soon as their condition permits. As strength increases, the training program can be made more rigorous. Cycling movements and exercises in the standing machine while strapped in help build muscle and improve coordination and the impaired sense of balance. The exercises build nerve stimuli that help restore as many body functions as possible.Every encouraging result builds new self-confidence. Goals that are achievable, such as wheelchair sports and exchanges or joint activities with other people affected, also help.
