PMID- 33325011
OWN - NLM
STAT- MEDLINE
DCOM- 20201217
LR  - 20211221
IS  - 1833-3516 (Print)
IS  - 2209-1491 (Electronic)
IS  - 1833-3516 (Linking)
VI  - 50
IP  - 4
DP  - 2020 Dec 20
TI  - Acute spontaneous spinal cord infarction: Utilisation of hyperbaric oxygen 
      treatment, cerebrospinal fluid drainage and pentoxifylline.
PG  - 325-331
LID - 10.28920/dhm50.4.325-331 [doi]
AB  - INTRODUCTION: Spinal cord infarction (SCI) is a potentially devastating disorder 
      presenting with an acute anterior spinal artery syndrome, accounting for an 
      estimated 1% of stroke presentations. Aetiologies include aortic surgical 
      complications, systemic hypotension, fibrocartilaginous embolism and vascular 
      malformations. Diagnosis is clinical combined with restriction on 
      diffusion-weighted magnetic resonance imaging (MRI). There are no treatment 
      guidelines for non-perioperative cases although there is limited literature 
      regarding potential therapies, including hyperbaric oxygen treatment (HBOT) and 
      cerebrospinal fluid (CSF) drainage. We describe 13 cases of acute SCI, five 
      receiving HBOT, and three also receiving pentoxifylline and drainage of lumbar 
      CSF. METHODS: Data for all patients with MRI-proven SCI at Fiona Stanley Hospital 
      from 2014-2019 were reviewed. RESULTS: Thirteen patients, median age 57 years 
      (31-74), 54% female, were identified. Aetiologies: two fibrocartilaginous emboli; 
      seven likely atherosclerotic; two thromboembolic; two cryptogenic. All presented 
      with flaccid paraplegia except one with Brown-Sequard syndrome. Levels ranged 
      from C4 to T11. Five patients received HBOT within a median time of 40 hours from 
      symptom onset, with an average 15 treatments (10-20). Three of these received 
      triple therapy (HBOT, pentoxifylline, CSF drainage) and had median Medical 
      Research Council manual muscle testing power of 5, median modified Rankin Score 
      (mRS) of 1 and American Spinal Injury Association (ASIA) score of D on discharge, 
      compared with 2 power, mRS 3.5 and ASIA B in those who did not. CONCLUSIONS: SCI 
      can be severely disabling. Triple therapy with pentoxifylline, CSF drainage and 
      HBOT may reduce disability and further prospective trials are required.
CI  - Copyright: This article is the copyright of the authors who grant Diving and 
      Hyperbaric Medicine a non-exclusive licence to publish the article in electronic 
      and other forms.
FAU - Ashton, Catherine
AU  - Ashton C
AD  - Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.
AD  - Corresponding author: Dr Catherine Ashton, Neurology Department, Fiona Stanley 
      Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia, 
      catherine.ashton@health.wa.gov.au.
FAU - Banham, Neil
AU  - Banham N
AD  - Department of Hyperbaric Medicine, Fiona Stanley Hospital, Murdoch, Australia.
FAU - Needham, Merrilee
AU  - Needham M
AD  - Neurology Department, Fiona Stanley Hospital, Murdoch, Australia.
AD  - Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, 
      Australia.
AD  - Perron Institute for Neurological and Translational Science, Nedlands, Australia.
AD  - University of Notre Dame, Fremantle, Australia.
LA  - eng
PT  - Journal Article
PL  - Australia
TA  - Diving Hyperb Med
JT  - Diving and hyperbaric medicine
JID - 101282742
RN  - S88TT14065 (Oxygen)
RN  - SD6QCT3TSU (Pentoxifylline)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cerebrospinal Fluid
MH  - Cerebrospinal Fluid Leak
MH  - Drainage
MH  - Female
MH  - Humans
MH  - *Hyperbaric Oxygenation
MH  - Infarction
MH  - Male
MH  - Middle Aged
MH  - Oxygen
MH  - *Pentoxifylline/therapeutic use
MH  - Spinal Cord
PMC - PMC8026234
OTO - NOTNLM
OT  - Central nervous system
OT  - Hyperbaric oxygen treatment
OT  - Infarction
OT  - Outcome
OT  - Spinal cord
OT  - Stroke
OT  - Treatment
COIS- Conflicts of interest and funding: nil
EDAT- 2020/12/17 06:00
MHDA- 2020/12/18 06:00
PMCR- 2021/12/20
CRDT- 2020/12/16 05:39
PHST- 2020/05/15 00:00 [received]
PHST- 2020/08/09 00:00 [accepted]
PHST- 2020/12/16 05:39 [entrez]
PHST- 2020/12/17 06:00 [pubmed]
PHST- 2020/12/18 06:00 [medline]
PHST- 2021/12/20 00:00 [pmc-release]
AID - 10.28920/dhm50.4.325-331 [doi]
PST - ppublish
SO  - Diving Hyperb Med. 2020 Dec 20;50(4):325-331. doi: 10.28920/dhm50.4.325-331.