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Your Good Health: Spinal cord stroke leaves woman paralyzed from waist down

Spinal cord strokes are rare — 1% of all strokes, but can be devastating.
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Dr. Keith Roach

Dear Dr. Roach: My wife’s best friend (age 58) has always been a fitness and nutrition buff, but she suddenly lost the ability to move her right leg. She was admitted to the hospital and, after extensive tests, was diagnosed with a spinal cord stroke.

Basically, aside from urinary and bowel function, she is paralyzed from the waist down. She has been told that treatment with physical therapy is her only option. The reading I have done on my own does not give any positive news. Any information you can provide on this would be appreciated.

R.P.

Spinal cord strokes are rare — 1% of all strokes, but can be devastating, as is the case with your wife’s friend. I am very sorry for her.

Spinal cord strokes may come spontaneously, but are frequently a complication of several different surgeries. When spontaneous, they are most likely caused by blockages of the arteries due to cholesterol plaque, her healthy lifestyle notwithstanding. However, there are other less-common causes, including damage to the artery (such as a dissection) or arterial diseases like lupus, Behcet’s or polyarteritis nodosa. A blood clot can also cause a stroke. Sometimes a cause is never precisely identified.

Most people who have a spinal cord stroke do get better with physical therapy, but unfortunately, most still have some deficits. Up to half can regain the ability to walk. The improvement can take a long time, up to three years after the stroke. Treatment depends on the underlying reason for the stroke, if it is known. For example, if the stroke is (or strongly suspected to be) due to blockages in the arteries, medicines to prevent blood clots, like aspirin or clopidogrel (Plavix), are prescribed along with statin drugs.

Dear Dr. Roach: I am 75 years old and in very good health. I run five days a week and work out three. I was getting up six times a night or more to go to the bathroom. I went to the urologist, who prescribed silodosin to shrink my prostrate to make it easier to empty my bladder. My prostate is enlarged, which is common for my age.

I did not like the side effects and stopped taking the drug. I now self-catheterize three or four times a day. Since I started self-catheterizing, I go to bed at 11 p.m. and sleep until about 6 a.m. without getting up to go to the bathroom. Will there be any long-term negative effects to self-catheterizing?

M.P.R.

If a person cannot drain the bladder effectively by urinating, the bladder needs to be drained in another way to prevent kidney disease. A tube is one way to do that. This can be one you place yourself (intermittent self-catheterization); one that’s placed through the penile urethra into the bladder (a Foley catheter); or a surgically placed suprapubic catheter.

All of these can be effective at draining the bladder and preventing long-term damage to the kidney, but all share the potential for allowing bacteria into the bladder and causing urinary infections, which can be serious — even life-threatening. Intermittent self-catheterization and a suprapubic catheter have a lower risk of infection than a chronic, indwelling Foley catheter.

I recommend that you talk with your urologist about other options to reduce the blockage from your enlarged prostate. There are a variety of options, including traditional surgery and several substantially less-invasive techniques that are likely to keep you from having to self-catheterize.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu