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December 2020; 10 (6) Research

Spinal cord transient ischemic attack

Insights from a series of spontaneous spinal cord infarction

View ORCID ProfileStephen W. English, Alejandro A. Rabinstein, Eoin P. Flanagan, Nicholas L. Zalewski
First published December 4, 2019, DOI: https://doi.org/10.1212/CPJ.0000000000000778
Stephen W. English
Department of Neurology (SWE), Emory University, Atlanta, GA; and Department of Neurology (AAR, EPF, NLZ), Mayo Clinic, Rochester, MN.
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  • ORCID record for Stephen W. English
Alejandro A. Rabinstein
Department of Neurology (SWE), Emory University, Atlanta, GA; and Department of Neurology (AAR, EPF, NLZ), Mayo Clinic, Rochester, MN.
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Eoin P. Flanagan
Department of Neurology (SWE), Emory University, Atlanta, GA; and Department of Neurology (AAR, EPF, NLZ), Mayo Clinic, Rochester, MN.
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Nicholas L. Zalewski
Department of Neurology (SWE), Emory University, Atlanta, GA; and Department of Neurology (AAR, EPF, NLZ), Mayo Clinic, Rochester, MN.
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Citation
Spinal cord transient ischemic attack
Insights from a series of spontaneous spinal cord infarction
Stephen W. English, Alejandro A. Rabinstein, Eoin P. Flanagan, Nicholas L. Zalewski
Neurol Clin Pract Dec 2020, 10 (6) 480-483; DOI: 10.1212/CPJ.0000000000000778

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Abstract

Objective To define the prevalence and characteristics of spinal cord transient ischemic attack (sTIA) in a large retrospective series of patients who met diagnostic criteria for spontaneous spinal cord infarction (SCI).

Methods An institution-based search tool was used to identify patients evaluated at the Mayo Clinic in Rochester, MN, from 1997 to 2017 with spontaneous SCI (n = 133). Cases were subsequently reviewed for transient myelopathic symptoms preceding infarction that were suspected ischemic in nature. We performed a descriptive analysis of patients with sTIA before SCI.

Results Of 133 patients with a diagnosis of spontaneous SCI, we identified 4 patients (3%) who experienced sTIA before SCI. The median age at presentation was 61.5 years (range 46–75 years), 2 (50%) were women, and 3 (75%) had traditional vascular risk factors. Localization was cervical cord in 2 cases (50%) and thoracic cord in 2 cases (50%); all patients developed SCI in the same distribution as their preceding sTIA symptoms. All patients experienced recurrent sTIA before SCI. Symptoms ranged from seconds to a few minutes before returning to baseline. No patients had pain as a feature of sTIA.

Conclusions sTIAs are possible but rare in patients who subsequently have a SCI. Clinical features are similar to those of SCI, with rapid onset of severe myelopathic deficits, followed by prompt resolution. Vascular risk factors are common in these patients. Thus, recognition of a sTIA may represent a valuable opportunity for vascular risk factor modification and stroke prevention. However, given the rarity, physicians should explore other possible explanations when sTIA is considered.

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/cp.

  • Editorial, page 469

  • Received June 17, 2019.
  • Accepted October 3, 2019.
  • © 2019 American Academy of Neurology
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