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.