Abstract DP357: A Comparative analysis of Age-Related Risk Factors and Causes of Spontaneous Spinal Cord Infarction and Cerebral Ischemic Stroke

Introduction: Spontaneous spinal cord infarction (SCI) is a rare debilitating form of ischemic stroke affecting patients of all ages, with an unknown distribution of causes and risk factors (RFs). Cerebral ischemic stroke (CIS) typically affects older patients, but recent studies have shown CIS to be increasing in those < 50. We compared RFs and outcomes in SCI vs CIS, stratified by age. Methods: We analyzed data from two sources: (1) manually curated (MC) patient charts from an NYC academic hospital (2013–2024; 49 SCI, 49 CIS age-matched), and (2) de-identified data from 290+ million patients in EPIC Cosmos (9,546 putative SCI, 718,920 CIS). Chi-square tests were used to compare the prevalence of RFs among putative SCI and CIS cases in Cosmos, with sub-analyses for patients > 50 or < 50. Logistic regression in age-matched MC patients estimated odds of SCI vs CIS by RF, with subgroup analyses. Results: SCI patients had broader age distribution and younger median age (52 vs 71, Figure 1). In Cosmos, connective tissue disorders were significantly enriched in SCI. Hypertension (HTN) was most prevalent in all groups (Cosmos SCI 68%, CIS 76%; MC SCI 38%, CIS 58%), followed by hyperlipidemia (HLD) (Figure 2). HTN was overall less associated with SCI than CIS (OR 0.33, 95% CI 0.12–0.92), except in Cosmos patients <50 (Figure 2). In MC data, patients with SCI <50 were more likely to have HTN (OR 10.5, 95% CI 2.41–74, p=0.004) and HLD (OR 9.1, 95% CI 2.10–64.3, p=0.008) than those > 50, whereas patients with CIS >50 were more likely to have HTN (OR 10.7, 95% CI 2.94–46, p=0.0006) with no age difference for HLD. Trauma (OR 12, 95% CI 1.56–92.3, p=0.02) and aortic dissection (trend, OR 7, 95% CI 0.86–56.9) were more common in SCI (Figure 3). Conclusions: SCI was linked to higher rates of aortopathies and connective tissue disorders in Cosmos, with hematologic RFs (sickle cell disease, DVT, factor V Leiden) tied to SCI only in patients < 50. Similar trends appeared in MC data despite small sample size, suggesting rare mechanisms (dissection, trauma, thrombophilia) may contribute significantly to the broad age distribution of SCI patients. While HTN and HLD were associated with age > 50 for CIS, younger SCI patients with HTN or HLD had higher odds of SCI than older SCI patients. Subsets of patients with very poorly controlled or early onset vascular risk factors may thus be at increased risk for spontaneous SCI, though further research would be needed to determine this.