Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery

Sevük, Utkan; Kaya, Sedat; Ayaz, Fırat; Aktas, Ulas

doi:10.1111/jocs.12666

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…Another mechanism described in autopsy reports is small arterioles occlusion by cholesterol or atheromatous emboli [4,12,13], that could results from aortic atheroma disruption and fragmentation during VA-ECMO/ IABP implantation or coronary angiography, but also during withdrawal of the former, with subsequent occlusion of small vessels. As a matter of fact, this mechanism has been previously described in patients with IABP alone [13][14][15][16]. In our patients, SCI could have been consecutive to multiple injuries or different injury from one patient to another, such as mechanical trauma and/or arterial embolism of a spinal artery caused by the ECMO itself, coronary angiography or IABP, prolonged hypoperfusion and/or vasopressor use being precipitating, aggravating or triggering factors.…”

Section: Discussionmentioning

confidence: 57%

Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support

et al. 2020

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Spinal cord infarction (SCI) is a rare disease among central nervous system vascular diseases. Only a little is known about venoarterial extracorporeal membrane oxygenation (VA-ECMO)-related SCI. Retrospective observational study conducted, from 2006 to 2019, in a tertiary referral center on patients who developed VA-ECMO-related neurovascular complications, focusing on SCI. During this period, among the 1893 patients requiring VA-ECMO support, 112 (5.9%) developed an ECMOrelated neurovascular injury: 65 (3.4%) ischemic strokes, 40 (2.1%) intracranial bleeding, one cerebral thrombophlebitis (0.05%) and 6 (0.3%) spinal cord infarction. Herein, we report a series of six patients with refractory cardiogenic shock or cardiac arrest receiving circulatory support with VA-ECMO who developed subsequent SCI during ECMO course, confirmed by spine MRI after ECMO withdrawal. All six patients had long-term neurological disabilities. VA-ECMO-related SCI is a rare but catastrophic complication. Its diagnosis is usually delayed due to sedation requirement and/or ICU acquired weakness after sedation withdrawal, leading to difficulties in monitoring their neurological status. Even if no specific treatment exist for SCI, its prompt diagnosis is mandatory, to prevent secondary spine insults of systemic origin. Based on these results, we suggest that daily sedation interruption and neurological exam of the lower limbs should be performed in all VA-ECMO patients. Large registries are mandatory to determine VA-ECMO-related SCI risk factor and potential therapy.

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Section: Discussionmentioning

confidence: 57%

Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support

et al. 2020

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“…In the literature, cases of SC ischaemia after SA with and without hypotension have been described (5,6). Additionally, cases unrelated to SA due to hypotension only (7), after CABG surgery (8) or even cases of spontaneous SC ischaemia have been described (9).…”

Section: Introductionmentioning

confidence: 99%

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Costa¹,

Romualdo²,

Eugenio³

et al. 2017

Turk J Anaesth Reanim

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Case Report / Olgu Sunumu Spinal anestezi total kalça protezi ameliyatı için ilk seçenektir ve hafif komplikasyonlarının yanı sıra yaşamı tehdit edecek kadar ciddi komplikasyonları da vardır. Bazı spinal kord iskemisi vakaları tanımlanmış olmasına rağmen, nöroaksiyal anestezi sonrasında nörolojik komplikasyonların insidansı net değildir. Bu çalışmada, total kalça protezi için L2-L3 spinal anestezi uygulamasının ardın-dan gelişen tek taraflı T8-T11 spinal kord iskemi vakası sunulmaktadır. Manyetik rezonans görüntülemesi (MRI) sonucunda, sol paramediyan spinal kord hiperintens T8-T11 sinyal değişikliği bulundu. Hasar ile cerrahi arasında geçici bir epidemiyolojik bağ-lantının varlığı görülmektedir. Yaralanma, yara alanı ile spinal iğ-nenin giriş alanı arasında, anatomik yakınlık olmaksızın meydana geldi. Bu durum, sadece birinin yaralanmayı tek başına belirlemek için yeterli olmayacağı birçok faktörden kaynaklanabilir. Aynı anda hepsinin etkisiyle komplikasyon oluşabilir. Çalışmamızda sonuç öngörülemez ve kaçınılmazdı. Yetersiz tıbbi uygulamadan ziyade beklenmeyen durumlar bu sonuca yol açtılar.Anahtar kelimeler: Spinal kord yaralanmaları, spinal anestezi, kalça protezi artroplastisi, spinal kord iskemisi, iskemik miyelopati Spinal anaesthesia is the most preffered anesthesia technique for total hip replacement, and its complications range from low entity (insignificant) to life threatening. The incidence of neurologic complications after neuraxial anaesthesia is not perfectly clear, although there are several described cases of spinal cord ischaemia. We present a case of unilateral T8-T11 spinal cord ischaemia following L2-L3 spinal anaesthesia for total hip replacement. Magnetic resonance imaging showed a hyperintense T8-T11 signal alteration on the leftside of paramedian spinal cord. A temporal epidemiologic linkage between the damage and the surgery seems to be present. The injury occurred without anatomical proximity between the injury site and the spinal needle entry site. This may be due to multiple contributing factors, each of them is probably not enough to determine the damage by itself; however, acting simultaneously, they could have been responsible for the complication. The result was unpredictable and unavoidable and was caused by unforeseeable circumstances and not by inadequate medical practice.Keywords: Spinal cord injuries, spinal anaesthesia, arthroplasty, hip replacement, spinal cord ischaemia, ischaemic myelopathy Abstract / Öz

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Post‐ICU Care and Other Complications

2020

Manual of Perioperative Care in Adult Cardiac Surgery

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Paraplegia Due to Spinal Cord Infarction After Coronary Artery Bypass Graft Surgery

Abstract: Paraplegia is an extremely rare complication after coronary artery bypass grafting (CABG) and the underlying mechanisms remain poorly understood. We report a patient who developed paraplegia after CABG and review the literature on spinal cord ischemia following CABG surgery.

Cited by 6 publications

References 33 publications

Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support

Spinal cord infarction during venoarterial-extracorporeal membrane oxygenation support

Thoracic Unilateral Spinal Cord Injury After Spinal Anaesthesia for Total Hip Replacement: Fate or Mistake?

Post‐ICU Care and Other Complications

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