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69 year old man who awoke following an abdominal aortic aneurysm repair unable to move his lower extremities.

Vascular supply

Components:

one anterior spinal artery

two posterolateral spinal arteries

Anterior spinal artery

formed superiorly from branches from both vertebral arteries

Supplies anterior 2/3 of cord parenchyma (most of grey matter).

Collaterals

Fed by several radicular arteries in the cervical and upper thoracic regions

Main blood supply to the lower spinal cord (approximately T8 through the conus medullaris) is derived from the artery of Adamkiewicz.

Arterial: Occlusion of one of the feeding arteries of the cord (most common)

Several radiculo-medullary arteries supply the superior spinal cord

Reduces the incidence of infarction in adults

Watershed in children: cervico-thoracic atrophy with birth injury

Artery of Adamkiewicz supplies the majority of the blood flow to the inferior cord

occlusion of this vessel results in most infarcts

affects distal cord/conus

Sites (adult):

Upper thoracic (watershed)

Distal cord/conus (Adamkiewicz occlusion)

Venous: DAVF.

T1:

Thickened cord

May be hyper or hypointense

T2: increased signal within gray matter

“H-pattern”

Distal perforating branches supply gray matter

Metabolically active

“Owl-eyes”

Anterior 2/3 most prominently affected.

Cord Size

Enlargement of cord in acute stage

Atrophy (months after infarction)

Enhancement: within gray matter

“owl eyes” on post gad T1

“H-pattern”

Vertebral body infarction

Increased T2 signal.

Etiology

Hypotension

Iatrogenic

Aortic surgery

Aortography

Atherosclerosis/Diabetes

Sickle Cell/Polycythemia

Arteritis/Syphilis

Trauma/Disc herniation

Age: usu >60 years old.