Vascular
Obstruction of the artery of Adamkiewicz that feeds the anterior spinal
artery (usually due to atherosclerosis) will cause an infarction of the
cord. Typically, severe back pain and flaccid paralysis with pain and
deficiency in temperature sensation will develop within minutes or
hours.55 Level D2-4 will usually be
the affected sensory level. Vibration and proprioception will be
relatively preserved due to a different blood supply to the posterior
cord. Arteriovenous malformations can be small or large, and either
asymptomatic or cause radicular symptoms or sudden pain with various
neurological problems due to bleeding.56 An aggressive
spinal hemangioma can grow out of the vertebral body into the spinal
canal, compress the cord and spinal roots, and cause symptoms
accordingly. It typically appears in young adults and worsens during
pregnancy.57 An epidural or subdural hematoma of the
spine appears after trauma, epidural injection, coagulation
abnormalities, and thrombolytic therapy and causes the sudden appearance
of pain with various neurological problems up to complete paraplegia
within minutes or hours.58 Wegener granulomatosis is a
systemic necrotizing granulomatous vasculitis. Neurologic symptoms
mostly include peripheral neuropathy and mononeuritis multiplex, with
rare cases of meningeal involvement. Cervical spinal cord compression
leading to myelopathy has also been reported.59