When blood flow to the spinal cord is cut off or disrupted, it can result in a spinal stroke. While this condition is rare and only accounts for just over 1% of all strokes, it’s important to understand the signs and risk factors. Furthermore, it’s important to understand how the rehabilitation process works so that you can make your highest recovery possible.
This article will discuss some of the possible causes of a spinal stroke and treatments that can help promote recovery. Use the links below to jump straight to any section:
What Causes a Spinal Stroke?
The brain and the spinal cord are the two crucial organs within the central nervous system. The brain and spinal cord communicate throughout the body via neural messages that rely on blood supply and nutrients to function. These messages are also needed to control the body and many of its functions, such as the ability to walk and talk.
While the brain is known as the main control center of the central nervous system, the spinal cord also plays a critical role. It transports messages from the brain to the rest of the body and vice versa, especially for functions such as movement and sensation.
A spinal stroke occurs when the blood supply to the spinal cord is interrupted, blocking the flow of oxygen-rich blood. This deprives the spinal cord of oxygen and also inhibits nerve impulses throughout the brain and spinal cord. Lack of oxygen-rich blood in the spinal cord can result in cell damage and death, impacting proper function. Thus, adequate blood flow is necessary in order for nerve impulses to travel effectively throughout the central nervous system.
A spinal stroke can occur from two types of events: 1) an ischemic spinal stroke: when a blood clot blocks an artery, or 2) a hemorrhagic spinal stroke: when an artery bursts, causing bleeding in the spinal cord. Hemorrhagic spinal strokes are much less common than ischemic spinal strokes. It’s also worth noting that unlike other types of strokes, spinal strokes do not disrupt blood supply to the brain.
While the exact causes of an ischemic or hemorrhagic stroke vary, there are many contributing factors that can increase the risk of developing a spinal stroke, including:
- Hypertension (high blood pressure)
- High cholesterol
- Lack of exercise
- Vascular malformation (abnormal connection between spinal veins and arteries)
- Aneurysm (balloon-shaped area in the artery)
Many of these contributing factors cause a narrowing of the arteries from plaque buildup, which suppresses blood flow. Other risk factors, such as high blood pressure, damage the arterial walls. Therefore, it’s important to practice preventative care when possible to reduce the risk of developing a spinal stroke or more serious complications.
Signs and Symptoms of a Spinal Stroke
Understanding the signs and symptoms of a spinal stroke is important to help others seek emergency medical care. Timely treatment can help restore blood flow within the spinal cord as quickly as possible to help reduce the risk of severe disability or death.
Some of the most common symptoms of a spinal stroke include:
- Sharp back and neck pain
- Aching pain in the arms and legs
- Loss of temperature sensation
Symptoms can appear rapidly or develop over a few hours. However, symptoms usually vary depending on what part of the spinal cord was affected or damaged. If you notice someone showing these symptoms, urge them to seek emergency medical attention.
Dr. Cruz-Flores shared that about 20% to 25% of individuals without timely treatment resulted in death. Therefore, be sure to seek emergency medical attention if you or anyone around you experience any of these symptoms.
Treatments for Spinal Stroke
Diagnosing a spinal stroke can be challenging because the symptoms may be similar to those of other conditions. However, an MRI can help diagnose a spinal stroke because it produces a detailed image of the spine and shows the location/area of a blood clot or bleed. Therefore, if you suspect a spinal stroke and your doctor has not ordered an MRI, insist on one.
Once a spinal stroke has been diagnosed, doctors will be swift to administer treatment. Initial treatment of a spinal stroke aims to restore blood flow in the spine and prevent further complications.
Treatment depends on the type of spinal stroke. For instance, to treat an ischemic spinal stroke (caused by a blood clot), clot dissolving medication such as aspirin or tPA may be administered. Medication may also be prescribed to stabilize blood pressure or lower cholesterol. To treat a hemorrhagic spinal stroke (caused by a burst artery) emergency surgery may be necessary.
After initial treatment and stabilization, the recovery journey begins. Before discussing the rehabilitation process, it’s important to understand the potential physical and mental effects of a spinal stroke.
Effects of Spinal Stroke: What are They?
As previously mentioned, the spinal cord is essential for the relay of nerve impulses that control sensation and movement throughout the body. When a stroke occurs in the spinal cord, it often results in secondary effects that impair sensation and/or movement to some degree. How much these functions are affected depends on the location (i.e. at which level of the spinal cord) and the severity of the stroke.
Each level of the spinal cord controls movement and sensation from that specific part of the body and downward. For example, a thoracic (mid-back) spinal stroke can affect movement and sensation from the mid-back and down to the legs and feet. A cervical (neck area) spinal stroke can affect movement and sensation throughout the entire body from the neck down.
Because every spinal stroke is different, every survivor will experience different secondary effects. Generally speaking, a spinal stroke only affects movement and sensation to varying degrees. However, it can also affect other functions.
Secondary effects of a spinal stroke can include:
- Loss of sensation
- Difficulty walking
- Impaired hand function
- Breathing difficulties
- Urinary or bowel incontinence
- Muscle tone problems such as spasticity (uncontrolled tightening of the muscles) or flaccidity (lack of muscle tone)
Other complications may arise later in recovery if proper care is not taken such as muscle, joint, or nerve pain. Pressure ulcers can occur due to immobility. Additionally, when a spinal stroke impacts daily activities and quality of life, such as becoming wheelchair-bound, it can lead to depression and/or anxiety.
To reduce the chances of developing secondary side effects and maximize recovery it’s essential to take action and pursue rehabilitation as soon as possible.
Rehabilitation After Spinal Stroke
While damage to some of the cells in the spinal cord may not be reversible, there is hope to recover through the process of neuroplasticity. Neuroplasticity is the central nervous system’s ability to rewire itself by creating new neural pathways and strengthening existing ones.
During a spinal stroke, some neural pathways become damaged while others may not be affected and remain healthy. Neuroplasticity allows these healthy, undamaged parts of the spinal cord to take on new functions in place of the damaged areas. Usually, the less severe a spinal stroke the more spared (undamaged) neural pathways there are. Thus, the higher the chances of stimulating neuroplasticity and restoring function.
To stimulate neuroplasticity in the spinal cord, survivors must engage in massed practice, or high repetition of exercises. Practicing a skill repeatedly helps reinforce the importance of that skill so that the nervous system can improve it. Thus, neuroplasticity is a key element for rehabilitation especially in therapy.
There are different types of therapy that survivors can benefit from after a spinal stroke, such as:
In physical therapy, survivors are able to practice numerous exercises that help stimulate the spinal cord and promote neuroplasticity. There are various physical therapy exercises that focus on improving mobility after stroke. For example, survivors struggling with impaired movement in the leg after spinal stroke can help improve leg mobility by practicing high repetition of leg rehab exercises.
Occupational therapy focuses on helping individuals to restore as much functional independence as possible, while also learning how to adapt to their ability level. After a spinal stroke, many of the usual daily activities survivors are accustomed to can be challenging such as bathing or eating.
Fortunately, your occupational therapist can prescribe exercises that directly translate to the activities of daily living. They can also recommend adaptive equipment to help you accomplish more tasks independently. For example, adaptive utensils stay in your hand to help you get a grip of something more securely.
After a spinal stroke, survivors may struggle with sensation. Some may feel a pins-and-needles sensation or numbness on the affected areas. Fortunately, studies show that sensory retraining can help individuals repair and restore the sensorimotor system. With consistent practice of sensory retraining exercises, survivors can simulate the brain and improve sensation.
Since the brain is not usually affected by a spinal stroke, survivors may not experience speech or cognitive difficulties. Therefore speech and cognitive therapy is often not needed. However, individuals who suffer a spinal stroke along with a co-occurring brain stroke may need speech and/or cognitive therapy. Speech-Language Pathologists in particular are great resources in providing exercises tailored to your ability level.
Sometimes individuals may not get sufficient therapy time or sessions due to insurance limitations or other issues such as transportation to appointments. To keep yourself motivated and engaged in between therapy sessions, you can use gamified, neurorehabilitation devices such as FitMi for stroke recovery.
FitMi is an interactive, home exercise program that provides full-body rehabilitation exercises for neurological recovery. It adjusts to your ability level by unlocking more difficult exercises as you improve, and also keeps track of your progress. Best of all, FitMi can be used from the comfort of your own home without any interruptions so you can practice as much as you want.
Along with rehabilitation, it’s important to focus on prevention by avoiding the things that can increase the risk of having another spinal stroke such as quitting smoking and managing stress. It’s also crucial to adopt a healthy diet to prevent further complications and maintain overall health. For example, to improve blood pressure and cholesterol levels you can eat fruits, vegetables, and whole grain foods.
A spinal stroke can lead to a variety of effects that make life challenging. Fortunately, through therapy and lifestyle changes many survivors can recover. One study shows that about 30% of individuals could walk again with a walking aid and 40% were able to walk on their own after about 4 to 5 years of consistent rehabilitation.
Recovering from Spinal Stroke
Though a spinal stroke is not nearly as common as a brain stroke, it helps to understand what it is and how it can occur. It’s especially important to know the risk factors such as high blood pressure, diabetes, or lack of exercise, and practice preventative care when possible. Diagnosing a spinal stroke may be challenging, but knowing what signs and symptoms to look for can help you or a loved one seek proper medical attention and treatment.
While a spinal stroke can result in various effects such as impaired mobility and sensation, there is hope for recovery through neuroplasticity, which is best activated through massed practice. Engaging in rehabilitation such as physical or occupational therapy is essential to promote recovery and get back to the activities of daily living.