Spinal cord infarction in Chinese patients: Clinical features, risk factors, imaging and prognosis

Background: The clinical presentations, MRI findings and outcomes for spinal cord infarction (SCI) are well documented in the West but scarce in the East. We investigated the clinical characteristics of SCI patients and further analyzed etiologies and prognostic factors in Chinese subjects. Methods: We reviewed all SCI patients from March 1993 to March 2007. Clinical symptoms, laboratory and imaging findings as well as outcomes were retrospectively analyzed. Results: Twenty-two patients (12 female) were identified; their mean age was 57.6 years. Nine patients (40.9%) had probable etiologies, while 13 were cryptogenic (59.1%). The primary etiologies were aortic diseases. Hypertension was the most common vascular risk factor (50%). Most patients (10/22 = 45.5%) had thoracolumbar lesions (mainly at T₉-L₁), while cervical lesions (9/22 = 40.9%) were the second most common (mainly at C ₄-C₇). 'Owl's eyes' signs were common with the anterior spinal artery (93.8%) and central cord infarctions (50%) but not in the posterior spinal artery or transverse spinal infarctions. After a mean follow-up of 18 months, only 10 patients (10/22 = 45%) had good outcomes (independent walking or walking with 1 aid). Conclusion: Most SCI patients had acute, monophasic symptoms, reaching nadir in <24 h. The subjects frequently had acute pain near their lesions before SCI signs/symptoms (16/22 = 72.7%). Initial severe weakness (Medical Research Council score ≤2) and a young age at onset (55 years old) are correlated with poor recovery of motor functions.