Systemic intravenous thrombolysis and spinal stroke: a case report and review of the literature

Background: Spinal cord infarction (SCI) is associated with poor clinical outcome. Intravenous thrombolysis (IVT) is a well-established treatment for cerebral ischaemic stroke. However, its efficacy in SCI is unknown. Objective: We present a case of acute spinal cord ischaemia with significant improvement following thrombolysis and review the current literature to explore the safety and feasibility of this treatment. Methods: We reviewed the literature for cases of SCI that were treated with IVT. We reviewed their medical history, clinical presentation and the reported outcome. Results: Other than our case, our review includes 19 cases of SCI treated with IVT. Their mean age was 62.87±15.27 and 36% of them were women. Most of the cases were spontaneous and treated within 240 min of onset. Favourable outcome was achieved in 89% of cases, including the few cases treated within extended time window. No clinical worsening due to haemorrhage was reported in either case. Conclusions: IVT may be considered in certain settings as treatment for SCI following the appropriate work-up. Favourable outcome was achieved in most cases and no case experienced clinical worsening due to post-thrombolysis haemorrhage. Safety and efficacy of this approach need further investigation.