Anterior Spinal Artery Syndrome

by Carlo Raj, MD

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    00:01 Here’s an important topic.

    00:03 I’m going to slow down here just a little bit because I want us to be clear about things.

    00:08 Anterior spinal artery syndrome.

    00:11 Think about where you are.

    00:12 So this is spinal cord.

    00:14 First and foremost, do not confuse this with anterior cerebral artery, either on your boards or on your wards.

    00:21 It has nothing to do with the brain right now.

    00:24 So think about where the anterior spinal artery is.

    00:26 It’s located anteriorly, obviously, in the spinal cord and pretty much taking care of the motor aspect of the spinal cord.

    00:32 Is that clear? Granted it’s rare but, oh my goodness, you must be familiar with it and you’ll see why even more so as we continue this because I need to give you more information that is extremely current for your understanding.

    00:47 As you move anterior spinal artery all the way from the rostral to the caudal, Can you picture that? So, from the head and down towards the lower extremity.

    00:57 You are going to get to a point of approximately T8.

    01:02 And at the level of T8, it’s interesting because now, I want you to think about the spinal cord and think about what’s anterior to it, and I’m going to bring to your attention a structure called the abdominal aorta, okay? So, where are you right now? Level of T8.

    01:21 Why am I bringing this up? You’ll see in a second.

    01:24 And anterior to the spinal cord would be the abdominal aorta.

    01:29 There are branches of that abdominal aorta, which we then refer to as being arteries of Adamkiewicz.

    01:38 Once again, when you talk about spinal cord anatomy, be familiar with some of the vascular supply, especially at the level of T8, and specifically, this is called artery of Adamkiewicz.

    01:53 I want to expand upon this in a second.

    01:55 At this point, if you’re unfamiliar, please make sure that in anatomy, you refer to your vascular supply.

    02:01 Now, there’s infarction, could, of anterior two-thirds of the cord.

    02:06 So if there is anterior spinal artery occlusion, as rare as it may be, think about what part of spinal cord has been affected.

    02:14 Obviously, the anterior portion, about two-thirds of it.

    02:17 So quite a bit of the anterior portion.

    02:20 So therefore, what kind of tracts are we looking at? Affects the spinothalamic, the corticospinal.

    02:26 And once again, what will it spare? Dorsal column.

    02:30 Why did I say once again? Because if it’s syringomyelia or central canal type of syndrome, there also, the dorsal column is spared.

    02:40 Here, also, dorsal column is spared.

    02:45 Results in spastic paralysis and loss of pain and temperature sensation with intact joint positions sense and vibration.

    02:51 Why? Because the dorsal column is spared, but the pain and temperature would be affected, as will be the motor functioning.

    02:59 Now, in particular vascular pathology, this is actually a surgery type of a situation that I’m going to give you, and I’m going to expand upon this artery of Adamkiewicz.

    03:09 Have you had a chance to refer to it yet? And these are branches of the abdominal aorta.

    03:15 And if you did have anterior spinal artery syndrome or occlusion only, well, you would think that maybe perhaps -- you’ll notice here that there’s nothing about incontinence.

    03:26 Why? Because if it’s a spinal cord that’s being affected, would you expect there to be perhaps incontinence? The reason that you don’t is because around T8 and below, think about where you are, you can have collateral supply to your spinal cord via some of your branches of the abdominal aorta called artery of Adamkiewicz.

    03:52 I bring this to your attention because in surgery, you can have a patient that has abdominal aortic aneurysm, plus, anterior spinal artery syndrome in which you’ve lost all control of your spinal cord.

    04:06 So, what do you think the patient is going to present with? Here is an anterior spinal artery syndrome, plus, triple A, which then equals urinary incontinence.

    04:18 If you have missed what I’ve said, I know it’s a little bit complicated, I’d recommend that you listen to me a few times so that all the information that I’ve just given is conceptually digested through anatomy.

    About the Lecture

    The lecture Anterior Spinal Artery Syndrome by Carlo Raj, MD is from the course Spinal Cord Pathology.

    Included Quiz Questions

    1. The patient has no bowel or bladder dysfunction.
    2. The patient has sparing of the dorsal columns.
    3. The patient has preservation of the joint and vibration sense.
    4. The syndrome affects the spinothalamic and corticospinal tracts.
    5. The patient has infarction of the anterior 2/3 of the spinal cord.
    1. T8 and below
    2. T10 and below
    3. C1 and above
    4. C5 and above
    5. T6 and above
    1. Loss of the joint position and vibration sense.
    2. Dysfunction of the bladder causing incontinence.
    3. Loss of pain sensation.
    4. Loss of temperature sensation.
    5. Spastic type of paralysis.

    Author of lecture Anterior Spinal Artery Syndrome

     Carlo Raj, MD

    Carlo Raj, MD

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    By William J. on 13. July 2017 for Anterior Spinal Artery Syndrome

    Watching these is clearer, more concise, and far more efficient than going to any of my lectures. I easily learn in 5-10 minutes of watching Dr Raj what I would struggle to pick up in an hour of lectures at medschool.