When back pain could mean you've suffered a stroke in your spine
- Michael Pell, 69, from Dartmoor, experienced excruciating pain in his back
- The retired hairdresser had suffered a stroke in his spine that day in 2012
- He still struggles to walk, and can no longer carry anything when moving
Michael Pell experienced a sudden, excruciating pain in his back
Tending to his much-loved garden one winter's morning, Michael Pell experienced a sudden, excruciating pain in his back, which left his legs feeling dead.
The pain came on suddenly and, initially, Michael, from Dartmoor, Devon, thought one of the deer that roam the remote area had kicked him.
'It was like nothing I'd ever felt before,' says Michael, 69, a retired hairdresser. 'I noticed I had no sensation from my lower back to my knees. When I realised it wasn't an animal, I thought it might be severe cramp, as I'd been working outside for four hours, mostly on my knees.
'I crawled 100 yards to our back door. I then pulled myself half up, but still had no feeling in the top half of my legs. My wife, Penny, had to help me to sit down.
'Although my feet and ankles worked, I had no control over my lower legs. I also had a burning sensation around my buttocks and down most of my legs.'
What Michael had suffered that day in January 2012 was a stroke, not to his brain, as usually happens, but his spine.
Normally, a stroke is caused either by a blockage to the blood supply to the brain, or a bleed from a weakened blood vessel supplying the brain. With a spinal stroke, the same principles apply, but the blockage or bleed affects the spinal cord.
Stretching from the base of the brain to the small of the back, the spinal cord is a key part of the body's central nervous system, which transmits instructions from the brain to the rest of the body.
Like the brain, the cord needs a constant blood supply to provide oxygen and nutrients. if it is halted, the nerves quickly become damaged and some die. As a result, these stop sending messages from the brain to the muscles - which muscles this affects depends on where the stroke occurs.
Scroll down for video
If a person has a stroke around the mid-section of their spinal cord, they may suffer paralysis in their legs, but everything above this will be unaffected. But a stroke around the neck section of the spinal cord could affect the muscles in the arms.
The most common cause of spinal strokes, as with brain strokes, is a build-up of cholesterol plaque in an artery wall, which then blocks it. Alternatively, small vessels supplying the spine rupture, due to abnormalities of the vessel walls or malformations of the vessels, says Tony Rudd, professor of stroke medicine at London's King's College Hospital.
Some patients have a spinal stroke during surgery, for example, while treating an aneurysm, a bulge in a blood vessel, especially if it's in the aorta in the abdomen. A stent, or hollow tube, is usually inserted into the aorta to strengthen its wall. This temporarily blocks blood flow to the spine, so the risk of a spinal stroke increases.
What Michael had suffered that day in January 2012 was a stroke in his spine
'Obesity or smoking are also causes, as fatty deposits make arteries narrow and raise blood pressure, putting strain on the body,' says Professor Rudd. 'Normally, there is no warning: only in rare cases do patients experience a slight weakness in their legs briefly beforehand.' Of the 152,000 strokes in the UK each year, spinal strokes make up about 1.25 per cent, says the Stroke Association.
For some, 'a spinal stroke can prove fatal towards the neck, as it can have a devastating impact on nerves to muscles, which control breathing and the diaphragm', says Professor Rudd. most spinal stroke victims will survive, but are often left with life-long disabilities. 'Unfortunately, the prognosis for spinal stroke patients is not great,' says Professor Rudd.
While other parts of the brain are able to take over other functions in brain stroke patients, once the wires are cut in the spinal cord, there's no route for sensory messages.
My right leg still feels dead above the knee. I can stick a pin in it and don't feel anything. But, if our cat's tail lightly touches my bare leg, it's like an electric shock
Treatments include reducing the pressure of the cerebrospinal fluid, a clear liquid found in the cavities around the brain and spinal cord. Following spinal stroke, this can build up around where it struck. Draining some, via a lumbar puncture in the lower back, can reduce pressure, improving blood flow. 'Otherwise, the only treatment is rehabilitation through physiotherapy and exercise,' says Professor Rudd.
Alex Rankin, director of services at spinal injury charity Aspire, says spinal strokes bring different problems in different patients.
'Most people think of not being able to walk, but there can be loss of bladder and bowel function due to nerve damage, or skin issues including pressure sores, as they have lost their sense of touch.
'Most people cannot sweat below the level of their injury, so are more likely to overheat. they also face circulation issues and so are more likely to feel the cold. There can be pain issues, too.'
It can lead to fatal complications if the patient is left paralysed.
'Being more immobile puts patients at risk of pneumonia, caused by an infection in the lungs, and bladder infections. if they're lying for long periods, bed sores that become infected and lead to septicaemia - potentially fatal blood poisoning - become a concern,' says Professor Rudd.
Michael Pell had no idea of such risks when he suffered his spinal stroke: he thought he'd suffered a minor back injury, and even had lunch afterwards, although the 'deadness' in his legs and burning sensation remained.
Michael still struggles to walk, as he is so unsteady
Later that afternoon, he called NHS Direct, who recommended going to A&E. He underwent various examinations, but, initially, the cause was unclear. Spinal stroke can be hard to detect, and common causes of numbness in the legs are often explored first.
As the numbness in Michael's legs meant he'd lost control of his bowels and bladder, he stayed in hospital for further tests.
A week later, possible causes such as a slipped disc, trapped nerve, severe inflammation, or a tumour had been ruled out.
Because of continued weakness in his legs, he had an MRI scan of his spine, and spinal stroke was diagnosed. 'I'd never heard of it, but was relieved this stroke allowed me to function and talk,' says Michael, who, despite being a light social drinker and smoker, had been fit and active.
He remained in hospital for two weeks, where full feeling to his left leg and his ability to control going to the toilet returned. He learned to walk again using a Zimmer frame, before using a walking stick for a few months, while undergoing rehabilitation and physiotherapy.
Michael now takes daily medicines, including blood-thinning pills and cholesterol-lowering statins, to ward off stroke, and gabapentin, for long-term nerve damage, to dampen the burning sensation in his right leg. 'If I forget to take it, it's like I'm standing next to our Aga cooker,' he says.
'My right leg still feels dead above the knee. I can stick a pin in it and don't feel anything. But, if our cat's tail lightly touches my bare leg, it's like an electric shock. The nerves are so damaged, they act in an unusual way - the lighter the touch, the greater the sensation, it seems.'
Michael still struggles to walk, as he is so unsteady. He can no longer carry anything when moving. He continues to be a keen gardener, but uses a ride-on mower. He can't bend down easily, so he lies on the ground for less arduous tasks.
'My consultant said if feeling didn't return within 18 months, it never would. So, I've accepted I'll always walk with my leg dragging behind me,' says Michael.
'But I haven't let it stop me, and it has made me appreciate more what I can achieve in the garden.'
ngs.org.uk
Source: http://www.dailymail.co.uk/
.jpg){kind=icon}