Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

Dougho Park; Byung Hee Kim; Sang Eok Lee; Ji Kang Park; Jae Man Cho; Heum Dai Kwon; Su Yun Lee

doi:10.3389/fneur.2020.563553

Spinal Cord Infarction: A Single Center Experience and the Usefulness of Evoked Potential as an Early Diagnostic Tool

Front Neurol. 2020 Oct 27:11:563553. doi: 10.3389/fneur.2020.563553. eCollection 2020.

Authors

Dougho Park¹, Byung Hee Kim¹, Sang Eok Lee¹, Ji Kang Park², Jae Man Cho³, Heum Dai Kwon³, Su Yun Lee⁴

Affiliations

¹ Department of Rehabilitation Medicine, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.
² Department of Radiology, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.
³ Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.
⁴ Department of Neurology, Pohang Stroke and Spine Hospital, Pohang-si, South Korea.

Abstract

Background: Spinal cord infarction (SCI) is a rare disease and its early diagnosis is challenging. Here, we described the clinical features and imaging findings of SCI, and assessed the results of evoked potential (EP) studies to elucidate their diagnostic role in the early stage of SCI. Methods: We retrospectively analyzed 14 patients who had spontaneous SCI. The demographic, neurological, and temporal profiles of the SCI patients were identified. We reviewed the imaging findings and assessed the changes in them over time. To review EP, central motor conduction time (CMCT) and somatosensory evoked potential (SEP) values were obtained. We also enrolled 15 patients with transverse myelitis (TM), and compared the clinical, radiological and electrophysiological features between SCI and TM patients. Results: The ages of the SCI patients ranged from 54 to 73 years. Nine patients (64.3%) showed nadir deficits within 6 h. The most common type of clinical visit was via the emergency center. Nine patients (64.3%) presented with peri-onset focal pain. The median initial modified Rankin scale score was 3. For 9 patients (64.3%), initial T2 imaging findings were negative, but subsequent diffusion weighed imaging (DWI) showed diffusion restriction. Vertebral body infarction was observed in 5 patients (35.7%). EP data were available for 10 SCI patients. All 8 patients who had their CMCT measured showed abnormalities. Among them, motor evoked potentials were not evoked in 6 patients at all. SEP was measured in 10 patients, and 9 of them showed abnormalities; one of them showed no SEP response. For 5 patients, the EP studies were done prior to DWI, and all the patients showed definite abnormalities. The abnormalities in the EP findings of the SCI patients were more profound than those of the TM patients, even though the duration from the onset to the start of the study was much shorter for SCI patients. Conclusion: SCI can be diagnosed based on typical clinical manifestations and appropriate imaging studies. Our study also indicates that immediate sensory and motor EP study can have an adjuvant diagnostic role in the hyperacute stage of SCI, and can improve the accuracy of diagnosis.

Keywords: diffusion MRI; early diagnosis; motor evoked potential (MEP); somatosensory evoked potential (SEP); spinal cord infarction; transverse myelitis.