Abstract WP217: Association Between Atrial Fibrillation and Spinal Cord Infarction

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Saad A Mir ◽  
Sammy D Pishanidar ◽  
Alexander E Merkler ◽  
Babak B Navi ◽  
Hooman Kamel
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Spinal Cord ◽  
Aortic Surgery ◽  
Demographic Characteristics ◽  
Spinal Cord Infarction ◽  
Vascular Risk ◽  
Medicare Beneficiaries ◽  
Common Cause ◽  
Cord Injury

Introduction: Spinal cord infarction (SCI) is a rare ischemic event comprising 1% of all strokes. In many cases of SCI, the cause remains undetermined. Case reports have suggested a relationship between cardiac embolism and SCI, but the association between the most common cause of cardiac embolism, atrial fibrillation (AF), and SCI has not been evaluated. Hypothesis: AF is associated with SCI. Methods: We performed a retrospective cohort study using inpatient and outpatient claims data from 2008-2014 on a 5% sample of Medicare beneficiaries. Our predictor variable was AF, ascertained by previously validated ICD-9-CM codes. The primary outcome was SCI, defined as ICD-9-CM diagnosis code 336.1 (vascular myelopathy) among patients who underwent spinal magnetic resonance imaging to rule out a compressive lesion and who did not have a concomitant diagnosis of degenerate joint disease, the most common cause of non-traumatic compressive myelopathy. In sensitivity analyses, we also excluded SCI cases accompanied by codes for traumatic spinal cord injury, spinal cord abscess, or spinal or aortic surgery. Cox proportional hazards analysis was used to assess the relationship between AF and SCI while adjusting for demographic characteristics and vascular risk factors. Results: Among 1,638,461 patients with a mean 3.9 years of follow-up, 423,856 had AF and 22 developed SCI. The annual incidence of SCI was 8.2 (95% confidence interval [CI], 4.4-15.4) per million in patients with AF compared to 2.3 (95% CI, 1.3-4.0) per million per year in those without AF. After adjustment for demographic characteristics and vascular risk factors, AF was associated with a higher risk of SCI (hazard ratio [HR], 4.8; 95% CI, 1.7-13.6). The association between AF and SCI persisted or grew stronger after excluding those with concomitant diagnoses of spinal cord injury, spinal abscess, and spinal or aortic surgery. Conclusions: In Medicare beneficiaries, AF was associated with increased risk of subsequent SCI. These results suggest the need for a thorough evaluation of potential underlying cardioembolic sources in patients with otherwise unexplained SCI.

Abstract WMP65: Association Between Sinus Bradycardia and Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sammy D Pishanidar ◽  
Saad A Mir ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Stroke Risk ◽  
Sinus Bradycardia ◽  
Cryptogenic Stroke ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Medicare Beneficiaries

Background and Purpose: We assessed whether sinus bradycardia is an early sign of atrial dysfunction that might predispose to atrial thrombogenesis and therefore be associated with stroke risk. Methods: We retrospectively used inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries ≥ 66 years old from 2008-2014. Our predictor variable was sinus bradycardia, defined as ICD-9-CM code 427.8x. Our primary outcome was ischemic stroke, ascertained using a previously validated diagnosis code algorithm. Patients with ischemic stroke or atrial fibrillation/flutter prior to or at the time of a bradycardia diagnosis were excluded. We used Cox regression analysis adjusted for demographics and vascular risk factors to evaluate the association between sinus bradycardia and the risk of stroke. Patients were censored at the time of a diagnosis of atrial fibrillation/flutter. In a confirmatory analysis, we assessed whether sinus bradycardia was more common in patients with cryptogenic stroke compared to stroke due to large-artery atherosclerosis or small-vessel disease using data from the Cornell AcutE Stroke Academic Registry (CAESAR), which comprises all adults with acute stroke at New York-Presbyterian Hospital/Weill Cornell Medical Center from 2011 to 2014. Results: Among 1,417,069 Medicare beneficiaries (mean age 73.4 +/- 7.6 years) who were followed for a mean of 4.36 (+/- 1.8) years, 63,385 patients received a diagnosis of sinus bradycardia. Bradycardia was significantly associated with stroke in unadjusted analysis (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.6-1.8) but not after adjustment for demographics and vascular risk factors (HR, 0.9; 95% CI, 0.8-0.9). Among 608 patients with cryptogenic or non-cardioembolic stroke in CAESAR, 93 (15.3%) had sinus bradycardia. We did not find an association between sinus bradycardia and cryptogenic stroke after adjustment for demographics, stroke severity, insular infarction, and vascular comorbidities (OR 0.9, 95% CI 0.4-1.9). Conclusion: We found no association between sinus bradycardia and future stroke risk in stroke-free patients nor an over-representation of sinus bradycardia among cryptogenic strokes versus non-cardioembolic strokes.

Abstract 1122‐000032: Spinal Cord Infarction a Young Patient with a Hypoplastic Vertebral Artery

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ammar Jum'ah ◽  
Hassan Aboul Nour ◽  
Daniel Miller
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Vertebral Artery ◽  
Cervical Spinal Cord ◽  
Vertebral Artery Dissection ◽  
Vascular Risk Factors ◽  
Cervical Cord ◽  
Artery Dissection ◽  
Spinal Cord Infarction ◽  
Vascular Risk

Introduction : Rare presentation of disease processes is absolutely intriguing to the human mind. Spinal cord infarction is abundantly reported to be secondary to cardiological procedures, patients carrying multiple vascular risk factors and vertebral artery dissections. But for it to happen in a patient who is young, relatively healthy and without vascular risk factors is quite interesting. Herein, we present the case of a patient presented with bilateral upper extremity weakness, who has a hypoplastic right vertebral artery that has coincided with him being a professional gamer with exerting compression from video‐gaming posturing of “forward leaning with neck hyperextension”, resulting in cervical spinal cord infarction. Methods : Case report Results : Vertebral artery dissection was excluded by CTA and MRA. our hypothesis was that the patient is a professional gamer and his posture of leaning forward and neck hyper‐extension had a role in inducing his spinal cord infarction given the fact of him having a hypoplastic right vertebral artery. Conclusions : Vertebral artery disease is a well‐recognized cause of ischemia in the posterior cerebral circulation. Recently, however, cervical cord infarction, albeit being extremely rare, has been increasingly reported as a complication of vertebral artery diseases such as dissection. Awareness must be raised that such condition can also happen in the young population due to compression of the vertebral arteries, especially when one is hypoplastic.

Acute Quadriparesis in a Smoker

2021 ◽  
pp. 238-241
Author(s):  
Nicholas L. Zalewski
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Vascular Risk Factors ◽  
Spinal Cord Infarction ◽  
Imaging Findings ◽  
Vascular Risk ◽  
Resonance Imaging ◽  
High Doses

A 51-year-old woman was seen for evaluation of transverse myelitis. Pertinent medical history included hypertension, hyperlipidemia, and 50 pack-years of cigarette smoking. Two months earlier, she was shopping and suddenly had excruciating pain in her upper back. Two hours later, severe weakness of both hands developed abruptly. Over the next 8 hours, severe paraparesis and urinary retention developed, with inability to lift legs against gravity, and she reported a T1 sensory level. Review of the outside magnetic resonance imaging noted key imaging findings, including initially normal magnetic resonance imaging within the first 12 hours of symptom presentation, and subsequent magnetic resonance imaging on day 3 showing anterior pencil-like hyperintensity on sagittal view and anterior U- or V-shaped pattern on axial view (termed U/V pattern), without associated gadolinium enhancement. Diffusion-weighted imaging was not obtained. Given the rapid, severe deficits with pain, spinal cord infarction was considered most likely, and the magnetic resonance imaging findings were typical. Magnetic resonance angiography of the neck with T1-fat-saturated views was obtained and did not show dissection. Laboratory evaluation showed a low-density lipoprotein value of 124 mg/dL and hemoglobin A1c of 6.2%. The patient was diagnosed with probable spontaneous spinal cord infarction on the basis of diagnostic criteria. The patient was counselled on smoking cessation, started on an aspirin and statin regimen, and followed up by a primary care provider for management of vascular risk factors. Residual neuropathic pain was treated with high doses of gabapentin. Importantly, unnecessary additional immunotherapy was avoided by establishing the correct diagnosis. Spontaneous spinal cord infarctions are an underrecognized cause of acute myelopathy. Spinal cord infarctions generally occur in older persons, with most cases associated with typical vascular risk factors, arterial dissection, and fibrocartilaginous embolism; historically, cases were often secondary to syphilis.

scholarly journals Spinal cord transient ischemic attack

2019 ◽  
Vol 10 (6) ◽  
pp. 480-483 ◽  
Author(s):  
Stephen W. English ◽  
Alejandro A. Rabinstein ◽  
Eoin P. Flanagan ◽  
Nicholas L. Zalewski
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Transient Ischemic Attack ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Cervical Cord ◽  
Spinal Cord Infarction ◽  
Vascular Risk ◽  
Risk Factor Modification ◽  
Ischemic Attack

ObjectiveTo define the prevalence and characteristics of spinal cord transient ischemic attack (sTIA) in a large retrospective series of patients who met diagnostic criteria for spontaneous spinal cord infarction (SCI).MethodsAn institution-based search tool was used to identify patients evaluated at the Mayo Clinic in Rochester, MN, from 1997 to 2017 with spontaneous SCI (n = 133). Cases were subsequently reviewed for transient myelopathic symptoms preceding infarction that were suspected ischemic in nature. We performed a descriptive analysis of patients with sTIA before SCI.ResultsOf 133 patients with a diagnosis of spontaneous SCI, we identified 4 patients (3%) who experienced sTIA before SCI. The median age at presentation was 61.5 years (range 46–75 years), 2 (50%) were women, and 3 (75%) had traditional vascular risk factors. Localization was cervical cord in 2 cases (50%) and thoracic cord in 2 cases (50%); all patients developed SCI in the same distribution as their preceding sTIA symptoms. All patients experienced recurrent sTIA before SCI. Symptoms ranged from seconds to a few minutes before returning to baseline. No patients had pain as a feature of sTIA.ConclusionssTIAs are possible but rare in patients who subsequently have a SCI. Clinical features are similar to those of SCI, with rapid onset of severe myelopathic deficits, followed by prompt resolution. Vascular risk factors are common in these patients. Thus, recognition of a sTIA may represent a valuable opportunity for vascular risk factor modification and stroke prevention. However, given the rarity, physicians should explore other possible explanations when sTIA is considered.

scholarly journals Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 651-658
Author(s):  
Kath M Bogie ◽  
Steven K Roggenkamp ◽  
Ningzhou Zeng ◽  
Jacinta M Seton ◽  
Katelyn R Schwartz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
User Interface ◽  
Veterans Health Administration ◽  
Study Cohort ◽  
Veterans Health ◽  
Health Administration ◽  
Cord Injury

ABSTRACT Background Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran’s Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. Methods The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans’ EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort’s free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. Results The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. Conclusion The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

scholarly journals The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis

Spinal Cord ◽  
2021 ◽  
Author(s):  
Peter Francis Raguindin ◽  
Gion Fränkl ◽  
Oche Adam Itodo ◽  
Alessandro Bertolo ◽  
Ramona Maria Zeh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Blood Pressure ◽  
Spinal Cord ◽  
Cardiovascular Risk ◽  
Meta Analysis ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Cord Injury

Abstract Study design Systematic review and meta-analysis. Objective To determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI). Methods We searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162). Results We screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, −14.5 mmHg, 95% CI −19.2, −9.9; −7.0 mmHg 95% CI −9.2, −4.8, respectively), lower triglycerides (−10.9 mg/dL, 95% CI −19.7, −2.1), total cholesterol (−9.9 mg/dL, 95% CI −14.5, −5.4), high-density lipoprotein (−1.7 mg/dL, 95% CI −3.3, −0.2) and low-density lipoprotein (−5.8 mg/dL, 95% CI −9.0, −2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (−10.3 mmHg, 95% CI −13.4, −7.1; −5.3 mmHg 95% CI −7.5, −3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies. Conclusion In SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

Transforaminal Lumbar and Thoracic Interventions and Ischemic Spinal Cord Injury

2016 ◽  
Author(s):  
Scott E. Glaser ◽  
Rinoo Shah
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Infarction ◽  
Supporting Evidence ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Root Cause ◽  
Cord Injury ◽  
Epidural Steroid ◽  
Ischemic Spinal Cord Injury

Transforaminal epidural steroid injections have been shown to be associated with catastrophic neurologic complications secondary to spinal cord infarction. The reflexive, ad hoc response of practitioners to these injuries has been to recommend risk minimization strategies to prevent embolism of the injected particulate steroids and to use nonparticulate steroids. This focus on distal embolism as the sole or primary cause of catastrophic outcomes lacks conclusive supporting evidence and does not suffice to protect the patient from paraplegia as it fails to address the root cause of the complications. A root cause analysis of the procedure provides evidence that the injection technique itself—the “safe triangle”—creates a risk of arterial damage and sequelae leading to ischemia of the spinal cord. The evidence is strong that the only way to mitigate or eliminate the risk of paraplegia is to use a different technique to perform transforaminal injections: the Kambin triangle approach. This change in technique is the only definitive solution that addresses the root cause of these catastrophic sequelae associated with transforaminal epidural steroid injections. Key Words: Artery of Adamkiewicz, ischemic spinal cord injury, Kambin triangle, safe triangle, transforaminal epidural injection

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