Barzilai University Medical Center

109 Research Day 2020 Barzilai University Medical Center 77 ACUTE SPINAL CORD ISCHEMIA TREATED WITH INTRAVENOUS THROMBOLYSIS Elena Dorodnicov, Anna Gelfand, Ron Milo Department of Neurology, Barzilai University Medical Center, Ashkelon Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva Introduction Spinal cord ischemia is rare but may be disastrous. Thrombolytic treatment has been rarely reported in spinal cord stroke with variable degrees of success but no consensus guidelines or treatment recommendations exist. Hypothesis Thrombolysis is safe in spinal cord infarct. Objectives To describe a case of clinically-diagnosed acute spinal cord ischemia treated by intravenous (IV) recombinant tissue-plasminogen activator (rtPA). Methods A 55 years old man with a medical history of obesity, arterial hypertension and dyslipidemia was admitted to ER 45 minutes after the onset of chest and back pain, dizziness and paralysis of 4 limbs. Neurological examination showed flaccid paraplegia and severe paresis in the arms, areflexia, bilateral extensor plantar response, anesthesia for pain and temperature below D4-5 level and in both arms, with sparing of vibration and position senses, compatible with anterior spinal artery syndrome. CT of the brain and CT-angiography were normal. The patient was treated with IV rTPA 4 hours after stroke onset. Results Diffusion-weighted MRI performed 24 hours later showed a longitudinal infarct of the spinal cord extending from C4 to D2 segments. There were no side effects related to the treatment and only mild improvement in upper limbs weakness was noted. Conclusions IV rTPA may be safely used in acute spinal cord ischemia. However, more data and recommendations are needed.