Spinal Cord Infarction Mimicking Angina Pectoris

doi:10.4065/75.11.1197

Mayo Clinic Proceedings

Volume 75, Issue 11, November 2000, Pages 1197-1199

https://doi.org/10.4065/75.11.1197 Get rights and content

Severe chest pain resembling angina pectoris in a 42-year old man preceded the development of neurologic signs, distracting from recognition of the acute infarction of the cervical spinal cord responsible for his pain. Consistent with a spinal origin of chest pain were the absence of any evidence of cardiac disease and the demonstration of infarction at C6-7. This segmental level coincides with the convergence of ascending afferent traffic entering the cen tral nervous system from the cardiac plexus. Spinal stroke affecting the lower cervical level can thus mimic the pain of myocardial ischemia.

Section snippets

REPORT OF A CASE

A healthy 42-year-old man driving his mules hoisted one of the reins above his head and felt pain shoot down his left arm. While steering the mules toward the barn, his left grip lessened. Then, while resting, he was struck with severe chest pain and dyspnea. Substernal pressure—like pain intensified and felt as if someone were sitting on his chest.

Evaluation in the emergency department focused on the overriding complaint of severe chest pain. Its urgency overshadowed the left arm weakness,

DISCUSSION

The diagnosis of spinal cord infarction in retrospect was established by the history of rapidly evolving cervical myelopathy with neurologic deficits similar to the Brown-Séquard syndrome. Neuroimaging confirmed this and excluded such alternate possibilities as hematomyelia, arteriovenous malformation, cervical stenosis, or tumor. Acutely, however, the diagnosis was ambiguous because the patient's initial neurologic deficits were subtle and surpassed by the more distressing symptom of severe

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Spinal cord infarction with cervical angina
2013, Journal of the Neurological Sciences
Citation Excerpt :
There is some possibility that the pain was mediated by involvement of dorsal horn afferents within the spinal cord at C7–T1 involved in the spinothalamic system. Just one case of spinal cord infarction with cervical angina has previously been reported [8], with the present case representing only the second case. The present findings suggest that spinal cord infarction should be included among the differential diagnoses for bilateral arm palsy after chest pain.
Cervical angina is defined as chest pain resembling true cardiac angina but originating from disorders of the cervical spine. Cervical angina is caused by cervical spondylosis in most cases. A 66-year-old man presented with bilateral arm palsy after chest pain resembling angina pectoris. Neurological examination revealed motor and sensory disturbances of the C7 to T1 level, and magnetic resonance imaging showed a hyperintense spinal cord lesion on T2-weighted imaging. Spinal cord infarction was diagnosed. Severe sinus bradycardia was identified on admission, and improved over the course of 5 weeks. Sympathetic afferent fibers from the heart and coronary arteries generally have their cell bodies in the dorsal root ganglia of the C8 to T9 spinal segments. Electrical stimulation of cardiopulmonary afferent fibers excites spinothalamic tract cells in the T1 to T6 segments of the spinal cord. Spinal cord injury can result in the loss of supraspinal control of the sympathetic system and can cause bradycardia, as commonly seen in patients with severe lesions of the cervical or high-thoracic (T6 or above) spinal cord. Bradycardia in the present case suggested impairment of the sympathetic system at the cervical and thoracic levels. These findings indicated that cervical angina in this case was mediated through the sympathetic nervous system. This represents only the second report of cervical angina caused by spinal cord infarction.
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Case ReportSpinal Cord Infarction Mimicking Angina Pectoris

Section snippets

REPORT OF A CASE

DISCUSSION

Arch Phys Med Rehabii

Pain

Lancet

Neurosurg Clin N Am

General considerations of pain in the chest

Spinal cord infarction: etiology and outcome

Neurology

Spinal cord infarction

Stroke

Spinal stroke

Brain

Vertebral artery insufficiency in acute and chronic spinal trauma: with special reference to the syndrome of acute central cervical spinal cord injury

J Neurosurg

Infarction of the medulla and cervical cord after fitness exercises

Stroke

Myelop-athy following cervical spine manipulation

Am J Phys Med

Case Report
Spinal Cord Infarction Mimicking Angina Pectoris