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Treatment of Vascular Myelopathies

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This article reviews the treatment of vascular myelopathies of various causes, with an emphasis on the treatment and prevention of the most common non-traumatic etiologies: ischemia secondary to open and endovascular interventions for treatment of thoracoabdominal aortic aneurysms and spontaneous (non-periprocedural) spinal cord ischemia and infarction.

Recent findings

Acute vascular myelopathies can present as sudden or rapid onset of paraplegia or quadriplegia. In such cases, spine MRI allows rapid and reliable exclusion of compressive or hemorrhagic lesions and may identify acute spinal cord ischemia; thus, it should be the preferred radiological technique for the evaluation of patients with suspected acute vascular myelopathy. Pressure-based protocols have improved the safety of intra- and post-procedural prophylactic and therapeutic cerebrospinal fluid drainage during thoracic aortic procedures, including open and endovascular treatment of thoracic aortic aneurysms and aortic valve replacements. Increasingly sophisticated and staged endovascular approaches to treat aortic aneurysms have greatly reduced the risk of spinal cord infarction and may not require prophylactic drainage in some cases. Spontaneous spinal cord infarction is less common, and acute treatment remains experimental.

Summary

Acute myelopathies may be caused by various forms of vascular disease, and some of those causes can be treatable. Emergency MRI is often necessary to guide therapeutic interventions.

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Chris Marcellino MD

  2. Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Chris Marcellino MD & Alejandro A. Rabinstein MD

  3. Department of Neurology, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA

    Nicholas L. Zalewski MD

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  1. Chris Marcellino MD
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  2. Nicholas L. Zalewski MD
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  3. Alejandro A. Rabinstein MD
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Correspondence to Alejandro A. Rabinstein MD.

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Marcellino, C., Zalewski, N.L. & Rabinstein, A.A. Treatment of Vascular Myelopathies. Curr Treat Options Neurol 23, 35 (2021). https://doi.org/10.1007/s11940-021-00689-x

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