Anterior Spinal Artery Syndrome

The anterior spinal artery supplies the anterior two-thirds of the spinal cord and runs along the entire length of the anterior surface of the spinal cord. If the blood flow through the anterior spinal artery becomes occluded, the anterior two-thirds of the spinal cord will suffer an infarct, resulting in bilateral lower extremity paresis or paraplegia with loss of pain and temperature sensation. This clinical manifestation is known as anterior spinal artery syndrome (ASAS). There will be the preservation of proprioception, vibratory sense, and fine touch. The neurological deficits will manifest below the level of insult due to the anatomical distribution of the spinal cord tracts affected.The ASAS is a rare cause of spinal cord acute ischemic myelopathy but is the most common cause of spinal cord infarcts. The neurological clinical deficit was first described in 1904 by Preobraschenki, while the pathoanatomical description was documented in 1909 by Spider. ASAS is caused by any etiology that decreases or affects blood flow to the anterior spinal artery, most commonly, aortic surgery and atherosclerotic disease. Prognosis is generally poor, as there is no acute management available for ASAS. Management consists of identifying the underlying etiology, treatment of symptoms, and prevention of complications.