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Vascular myelopathy: causes and mechanisms, possibilities of diagnosis and treatment

https://doi.org/10.14412/2074-2711-2018-1-12-16

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Abstract

Vascular myelopathy is a rare severe disease caused by a broad spectrum of causes, among which pathology of the aorta and its branches, aortic surgery, spinal diseases, and spinal trauma occupy the main place. The processes of neuroinflammation and glutamate neurotoxicity play a leading role in the pathogenesis of myeloischemia. The clinical picture of the disease is nonspecific and depends on the location and volume of an ischemic focus. Magnetic resonance imaging is a gold standard for diagnosis. However, this method remains insensitive in the acute period and fails to detect spinal cord ischemia at preclinical stages. The investigation and introduction of specific biochemical markers (glutamate receptors and their antibodies) for neurotoxicity, which can identify ischemia in the advanced stage and predetermine its development, are promising. The treatment of vascular myelopathy has not currently been standardized and it is mainly pathogenetic and symptomatic.

About the Authors

G. V. Ponomarev
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



A. A. Skoromets
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



V. S. Krasnov
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



O. V. Rodionova
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



D. D. Glistenkova
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



N. F. Porkhun
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



S. A. Dambinova
Academician I.P. Pavlov First Saint Petersburg State Medical University, Ministry of Health of Russia
Russian Federation

Department of Neurology, 

6–8, Lev Tolstoy St., Saint Petersburg 197022



References

1. Weidauer S, NichtweiІ M, Hattingen E, Berkefeld J. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015 Mar;57(3):241-57. doi: https://doi.org/10.1007/s00234-014-1464-6

2. Gaillard F. Acute spinal cord ischaemia syndrome. https://radiopaedia.org/articles/acutespinal-cord-ischaemia-syndrome

3. Novy J, Carruzzo A, Maeder P, Bogousslavsky J. Spinal Cord Ischemia: Clinical and Imaging Patterns, Pathogenesis, and Outcomes in 27 Patients. Arch Neurol. 2006 Aug;63(8):1113-20. doi: https://doi.org/ 10.1001/archneur.63.8.1113

4. Martirosyan NL, Feuerstein JS, Theodore N, et al. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine. 2011 Sep;15(3):238-51. doi: https://doi.org/10.3171/2011.4.spine 10543

5. Скоромец АА, Скоромец АП, Скоромец ТА, Тиссен ТП. Спинальная ангионеврология. Руководство для врачей. Москва: МЕД-пресс-информ; 2003. 608 c. [Skoromets AA, Skoromets AP, Skoromets TA, Tissen TP. Spinal'naya angionevrologiya. Rukovodstvo dlya vrachei [Spinal angineurology. A guide for physicians]. Moscow: MEDpress-inform; 2003. 608 p.]

6. Hussain MS, Shuaib A, Siddiqi ZA. Spinal cord transient ischemic attacks: a possible role for abciximab. Neurology. 2005 Feb 22;64(4): 761-2. doi: https://doi.org/10.1212/01.wnl. 0000152051.18941.01

7. Nedeltchev K, Loher TJ, Stepper F, et al. Long-term outcome of acute spinal cord ischemia syndrome. Stroke. 2004 Feb;35(2): 560-5. Epub 2004 Jan 15. doi: https://doi.org/10. 1161/01.str.0000111598.78198.ec

8. Hdiji O, Bouzidi N, Damak M, Mhiri C. Acute aortic dissection presenting as painless paraplegia: a case report. J Med Case Rep. 2016 Apr 5;10:99. doi: https://doi.org/10.1186/ s13256-016-0881-z

9. Wong JJ, Dufton J, Mior SA. Spontaneous conus medullaris infarction in a 79-year-old female with cardiovascular risk factors: a case report. J Can Chiropr Assoc. 2012 Mar:56(1):58-65

10. Amanieu C, Hermier M, Peyron N, et al. Spinal dural arteriovenous fistula. Diagn Interv Imaging. 2014 Sep;95(9):897-902. doi: https://doi.org/10.1016/j.diii.2013.08.007

11. Евзиков ГЮ, Бублиевский ДВ, Кондрашин СА и др. Спинальные дуральные артериовенозные фистулы: патогенез, клинические проявления, диагностика, лечение. Неврология, нейропсихиатрия, психосоматика. 2015;7(3):4-9. [Evzikov GYu, Bublievskii DV, Kondrashin SA, et al. Spinal dural arteriovenous fistulas: Pathogenesis, clinical manifestation, diagnosis, treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2015;7(3):4-9 (In Russ.)]. doi: 10.14412/2074-2711-2015-3-4-9

12. Шулешова НВ, Скоромец АА, Голиков КВ и др. Артериовенозные мальформации спинного мозга (классификация, клиническая картина, диагностика, принципы лечения). Санкт-Петербург; 2013. 22 с. [Shuleshova NV, Skoromets AA, Golikov KV, et al. Arteriovenoznye mal'formatsii spinnogo mozga (klassifikatsiya, klinicheskaya kartina, diagnostika, printsipy lecheniya) [Arteriovenous malformations of the spinal cord (classification, clinical picture, diagnostics, principles of treatment)]. Saint-Petersburg; 2013. 22 p.]

13. Acker G, Schneider UC, Grozdanovic Z, et al. Cervical disc herniation as a trigger for temporary cervical cord ischemia. J Spine Surg. 2016 Jun;2(2):135-8. doi: https://doi.org/10.21037 /jss.2016.06.04

14. Evaniew N, Belley-Cote EP, Fallah N, et al. Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. J Neurotrauma. 2016 Mar 1;33(5):468-81. doi: https://doi.org/10.1089/neu.2015.4192

15. Grassner L, Maier D. Impact of surgery on the outcome after spinal cord injury – current concepts and an outlook into the future. Neural Regen Res. 2016 Dec;11(12):1928-9. doi: https://doi.org/10.4103/1673-5374.197132

16. Duprez TP, Danvoye L, Hernalsteen D, et al. Fibrocartilaginous embolization to the spinal cord: serial MR imaging monitoring and pathologic study. AJNR Am J Neuroradiol. 2005 Mar; 26(3):496-501

17. Nelson JA, Ho CY, Golomb MR. Spinal Cord Stroke Presenting With Acute Monoplegia in a 17-Year-Old Tennis Player. Pediatr Neurol. 2016 Mar;56:76-79. doi: https://doi.org/10.1016 /j.pediatrneurol.2015.11.007

18. Panov AV. Mitochondrial Dysfunction and Markers of Spinal Cord Injury. In: Dambinova SA, Hayes RL, Wang KK, editors. Biomarkers for Traumatic Brain Injury. The Royal Society of Chemistry: Cambridge; 2012. P. 107-9.

19. Barbon A, Fumagalli F, Caracciolo L, et al. Acute spinal cord injury persistently reduces R/G RNA editing of AMPA receptors. J Neurochem. 2010 Jul;114(2):397-407. doi: https://doi.org/10.1111/j.1471-4159. 2010.06767.x

20. Kanellopoulos GK, Xu XM, Hsu CY, et al. White Matter Injury in Spinal Cord Ischemia: Protection by AMPA/Kainate Glutamate Receptor Antagonism. Stroke. 2000 Aug;31(8): 1945-52. doi: https://doi.org/10.1161/01.str. 31.8.1945

21. Vargas MI, Gariani J, Sztajzel R, et al. Spinal Cord Ischemia: Practical Imaging Tips, Pearls, and Pitfalls. AJNR Am J Neuroradiol. 2015 May;36(5):825-30. doi: https://doi.org/10. 3174/ajnr.a4118

22. Amarouche M, Hart JL, Siddiqui A, et al. Time-resolved contrast-enhanced MR angiography of spinal vascular malformations. AJNR Am J Neuroradiol. 2015 Feb;36(2):417-22. doi: https://doi.org/10.3174/ajnr.a4164

23. Brunnekreef GB, Heijmen RH, Gerritsen WB, et al. Measurements of cerebrospinal fluid concentrations of S100beta protein during and after thoracic endovascular stent grafting. Eur J Vasc Endovasc Surg. 2007 Aug;34(2):169-72. doi: https://doi.org/10.1016/j.ejvs.2007.01.013

24. Hulme CH, Brown SJ, Fuller HR, et al. The developing landscape of diagnostic and prognostic biomarkers for spinal cord injury in cerebrospinal fluid and blood. Spinal Cord. 2017 Feb;55(2):114-25. doi: https://doi.org/10.1038/ sc.2016.174

25. Albadawi H, Chen JW, Oklu R, et al. Spinal Cord Inflammation: Molecular Imaging after Thoracic Aortic Ischemia Reperfusion Injury. Radiology. 2017 Jan;282(1):202-11. doi: https://doi.org/10.1148/radiol.2016152222

26. Дамбинова СА, Скоромец АА, Скоромец АП, редакторы. Биомаркеры церебральной ишемии (разработка, исследование и практика). Санкт-Петербург: ИПК КОСТА; 2013. [Dambinova SA, Skoromets AA, Skoromets AP, editors. Biomarkery tserebral'noi ishemii (razrabotka, issledovanie i praktika) [Biomarkers of cerebral ischemia (design, research and practice)]. Saint-Petersburg: IPK KOSTA; 2013.]

27. Pelkey KA, McBain CJ. Ionotropic Glutamate Receptors in Synaptic Plasticity. In: Gereau RW , Swanson GT, editors. The Glutamate Receptors. Humana Press; 2008. P. 179-247

28. Rozas JL. Metabotropic Actions of Kainate Receptors in Dorsal Root Ganglion Cells. In: Rodriguez-Moreno A, Sihra TS, editors. Kainate Receptors. Novel Signaling Insights. Landes Bioscience and Springer Science+ Business Media; 2011. P. 69-81

29. Kuffler DP. Maximizing neuroprotection: where do we stand? The Clin Risk Manag. 2012;8:185-94. doi: https://doi.org/10.2147/ tcrm.s16196

30. Mü ller KI, Steffensen LH, Johnsen SH. Thrombolysis in anterior spinal artery syndrome. BMJ Case Rep. 2012 Sep 7;2012. pii: bcr 2012006862. doi: https://doi.org/10.1136/bcr2012-006862


For citation:


Ponomarev G.V., Skoromets A.A., Krasnov V.S., Rodionova O.V., Glistenkova D.D., Porkhun N.F., Dambinova S.A. Vascular myelopathy: causes and mechanisms, possibilities of diagnosis and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2018;10(1):12-16. (In Russ.) https://doi.org/10.14412/2074-2711-2018-1-12-16

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)