By virtue of being both difficult to distinguish from several other neurologic conditions while also qualifying as a relatively uncommon true vascular emergency, spinal cord infarction (SCI) poses a unique set of diagnostic and therapeutic challenges to clinicians. Though the condition carries high risk for severe disability if not promptly addressed, there is no consensus about the threshold for patients to be screened with emergent MRI or receive acute interventions such as IV-thrombolysis or endovascular therapy, in large part due to limited case data and a lack of statistically powered trials or formal guidelines. Moreover, multiple distinct pathologic processes can cause SCI, and there remains very limited understanding of which patient cohorts may be most susceptible to each stroke mechanism or respond favorably to the various possible treatments. Here, we present an in-depth analysis of a series of 14 SCI cases presenting to a network of 3 hospitals at a large academic center in New York City over a 5-year period to compare presenting symptoms, etiology, acute treatment strategy, and clinical outcomes. We review the results of 9 patients who were evaluated with digital subtraction angiography (DSA), including 2 patients receiving different multiple drug regimens of acute intra-arterial therapies. One patient was also found eligible and treated with IV-thrombolysis. In these data we also identify multiple patients who experienced SCI in the setting of sickle cell disease and other primary blood dyscrasias and track their functional outcomes. Overall these analyses provide preliminary evidence that spontaneous SCI is more likely to be related to an underlying hyper coagulable state or physical trauma in younger patients relative to older patients with more significant traditional vascular and embolic risk factor profiles.

Disclosures C. Chung: None. H. Ahmed: None. M. Oyer: None. C. Chornay: None. A. Khajawa: None. A. Kvernland: None. C. Zhang: None. E. Nossek: None. S. Kelly: None.