Patient handout

Spinal Cord Infarction (Anterior Spinal Artery Syndrome and other vascular cord lesions)

PRODUCTION

1. Your condition

This handout is for spinal cord infarction (anterior spinal artery syndrome and other vascular cord lesions). Your care team identified this based on: sudden flaccid paraparesis / quadriparesis + dissociated sensory loss (motor + pain/temp loss with preserved proprioception) — classical anterior spinal artery syndrome (zalewski jama neurol 2019 pmid 30264146).

Other reasons your team may use this plan: acute radicular / interscapular back pain followed within minutes by motor + sensory deficit at a discrete cord level (zalewski jama neurol 2019 pmid 30264146; yadav j stroke cerebrovasc dis 2018 pmid 30093205); post-operative paraplegia / paraparesis after thoracoabdominal aortic aneurysm repair or aortic dissection surgery (coselli j thorac cardiovasc surg 2016 pmid 26898979); elderly hyperextension injury with ue>le weakness (central cord syndrome) — overlap with ischemic central cord pattern (nasr/rabinstein 2017 pmid 28688063).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
maintain_MAP_>=85_mmHg_x_5-7d	—	—	—	Hemodynamic augmentation target MAP ≥85 mmHg × 5-7 d in acute SCI (Nasr/Rabinstein 2017 PMID 28688063 — TBI/SCI extrapolation; no SCI-specific RCT)

Plan: SCI hemodynamic augmentation + etiology-driven antithrombotic / statin + CSF drainage + neuropathic-pain ladder (Nasr/Rabinstein Curr Treat Options Neurol 2017 PMID 28688063; Coselli J Thorac Cardiovasc Surg 2016 PMID 26898979; Robertson Neurology 2011 PMID 22205760)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Doing well — on stable regimen + rehab

If you have:

no_new_weakness_or_numbness
no_new_back_pain
medications_taken_as_prescribed
rehab_attendance_consistent
bladder_bowel_routine_intact

Do this:

Continue secondary-prevention regimen (aspirin/anticoag + statin) as prescribed
Continue gabapentin/pregabalin + baclofen as titrated
Continue rehab + bladder/bowel/skin routine
Attend scheduled SCI / stroke clinic visits

YELLOW — Caution — call SCI / stroke clinic same day

If you have:

new_persistent_back_pain_x_>24h
worsening_neuropathic_pain
medication_side_effect
difficulty_with_catheterization
new_pressure_area

Do this:

Call the SCI / stroke clinic / rehab clinic same day
Do NOT stop secondary-prevention medication without instruction
Bring medication list to clinic call

RED — Emergency — call 911 / go to ED

If you have:

new_weakness_or_paralysis_in_any_limb
new_severe_back_or_chest_pain
new_difficulty_breathing
loss_of_bladder_or_bowel_control_acute
major_bleed
autonomic_dysreflexia_severe_BP_or_headache

Do this:

Call 911 / go to nearest ED
Bring medication list and SCI summary
Tell ED you have a history of spinal cord infarct on antithrombotic therapy

Call your provider if:

Any red-zone trigger
After any ED visit so SCI team is updated

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

High cervical SCI (C3-C5 phrenic) with FVC<15 mL/kg, NIF<−20, RR>30 or oxygen level (SpO₂)<92% (Nasr/Rabinstein 2017 PMID 28688063)(life-threatening)
CT angiogram aorta shows acute Type A or Type B dissection with cord syndrome (Nasr/Rabinstein 2017 PMID 28688063)(life-threatening)
SCI within 24-72 h of TAAA / open thoracic-aortic / TEVAR repair (Coselli J Thorac Cardiovasc Surg 2016 PMID 26898979)(life-threatening)
ASIA A (complete motor and sensory loss below level) at nadir (Robertson Neurology 2011 PMID 22205760)
Worsening ASIA grade / new deficit during admission despite MAP augmentation (Nasr/Rabinstein 2017 PMID 28688063)
Young (often pregnant or post-partum) patient with SCI after Valsalva / minor athletic trauma — fibrocartilaginous embolism suspicion (Nasr/Rabinstein 2017 PMID 28688063)
SCI in sickle cell disease vaso-occlusive crisis (Nasr/Rabinstein 2017 PMID 28688063)

5. Follow-up

SCI rehab (IRF / outpatient); neuropathic pain medication titration; spasticity management; mood / vocational; recurrent-event surveillance (etiology-driven) (Robertson Neurology 2011 PMID 22205760)

6. Sources

Guideline: Mayo Clinic 133-patient spontaneous SCI cohort + proposed diagnostic criteria (Zalewski JAMA Neurol 2019 PMID 30264146) + Mayo 115-patient long-term outcome (Robertson Neurology 2011 PMID 22205760) + Nasr/Rabinstein expert framework (Curr Treat Options Neurol 2017 PMID 28688063)