Background :
Spinal cord infarction is a rare but often devastating disorder caused by a wide array of pathologic states. Patients typically present with acute paraplegia or quadriplegia, depending on the level of the spinal cord involved. The diagnosis is generally made clinically, with neuroimaging to confirm the diagnosis and exclude other conditions.
Antiphospholipid (aPL) syndrome (APS) is a systemic autoimmune disorder associated with hypercoagulability and aPL antibodies, and it can occur in isolation (primary APS) or can accompany other systemic autoimmune disorders, such as SLE (secondary APS). There are few report APS as an etiologic factor for spinal cord infarction.
Methods: We performed a search for clinical studies of spinal cord infarction with antiphospholipid syndrome published up to Feb. 2019. We placed no restrictions on language or year of publication in our search, and we searched the following keywords: spinal cord infarction, antiphospholipid syndrome, anterior spinal artery syndrome, posterior spinal artery syndrome, paraplegia, quadriplegia.
Results: We identified 3 cases of SCI induced by APS. We added up to our case and confirmed four cases in total. Two cases were ASIA-A at thoracic level and our cases were ASIA-B and T5 / T5. In all 4 cases, APS was diagnosed with anti-cardiolipin antibody and no abnormality of coagulation factor was observed. We did not know if the rehabilitation protocol was performed, but there was no motor improvement in two cases and a 10% motor improvement in one case.
Conclusions :
APS is quite rare as an etiologic factor for spinal cord infarction. It is difficult to diagnose APS induced SCI definitively due to its rarity and MRI findings that are detected over time. This study noted that in patients with spinal cord infarction, APS should also be considered as an evaluation. In patients with acute spinal cord infarction, there is no space occupying lesion on neurologic imaging, and patients with coagulopathy symptoms should suspect APS. In three cases, SCI induced by APS showed no motor improvement or motor improvement as low as 10% . Perhaps acute complete artery occlusion may be the cause, but more research will be done.
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