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Introduction <p>Spinal cord infarction (SCI) is a rare but severe cause of acute myelopathy, and evidence supporting reperfusion therapies remains limited.</p> Methods <p>We report a 73-year-old man with spontaneous cervical SCI treated with intravenous alteplase and perform a systematic review (database search from inception to 13 November 2025) of case reports/series describing intravenous (IV) or intra-arterial (IA) thrombolysis for SCI, extracting data about clinical presentation, diagnostic and therapeutic work-up and functional outcomes.</p> Results <p>Our patient improved after thrombolysis and achieved functional independence at 3&#xa0;months (modified Rankin Scale [mRS] 2). The review identified 21 studies (19 case reports, 2 case series) totaling 25 patients; including our case, 26 patients were analyzed. Mean age was 57.4&#xa0;years (range 14–83), and anterior spinal artery (ASA) syndrome was the most common presentation. Most patients received IV thrombolysis; 4 underwent IA therapy (alone or combined). Considering the last available assessment, 14/25 patients (56.0%) had a favorable outcome (mRS 0–2), 8/25 (32.0%) had mRS 3, and 3/25 (12.0%) had mRS 4–5. No symptomatic treatment-related hemorrhagic complications were reported.</p> Discussion&#xa0;and Conclusion <p>Published experience suggests that thrombolysis in carefully selected patients with suspected SCI may represent a reasonably safe therapeutic option, but evidence is limited and subject to major bias. Prospective registries and multicenter studies are needed to clarify safety, efficacy, and selection criteria.</p>

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Thrombolysis in spinal cord infarction: Case report and systematic review

  • 期刊论文

  • 发表日期：

    2026年5月8日

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  • Andrea Di Pietro,
  • Emanuele Spina,
  • Carlo Maurea,
  • Antonio De Mase,
  • Giovanna Servillo,
  • Stefano Barbato,
  • Flavio Giordano,
  • Mario Muto,
  • Stefania Miniello,
  • Paolo Candelaresi,
  • Vincenzo Andreone

摘要

Introduction

Spinal cord infarction (SCI) is a rare but severe cause of acute myelopathy, and evidence supporting reperfusion therapies remains limited.

Methods

We report a 73-year-old man with spontaneous cervical SCI treated with intravenous alteplase and perform a systematic review (database search from inception to 13 November 2025) of case reports/series describing intravenous (IV) or intra-arterial (IA) thrombolysis for SCI, extracting data about clinical presentation, diagnostic and therapeutic work-up and functional outcomes.

Results

Our patient improved after thrombolysis and achieved functional independence at 3 months (modified Rankin Scale [mRS] 2). The review identified 21 studies (19 case reports, 2 case series) totaling 25 patients; including our case, 26 patients were analyzed. Mean age was 57.4 years (range 14–83), and anterior spinal artery (ASA) syndrome was the most common presentation. Most patients received IV thrombolysis; 4 underwent IA therapy (alone or combined). Considering the last available assessment, 14/25 patients (56.0%) had a favorable outcome (mRS 0–2), 8/25 (32.0%) had mRS 3, and 3/25 (12.0%) had mRS 4–5. No symptomatic treatment-related hemorrhagic complications were reported.

Discussion and Conclusion

Published experience suggests that thrombolysis in carefully selected patients with suspected SCI may represent a reasonably safe therapeutic option, but evidence is limited and subject to major bias. Prospective registries and multicenter studies are needed to clarify safety, efficacy, and selection criteria.