Spinal Cord Infarction Following Central-Line Insertion

Abstract

Hemothorax is a recognized complication of central line insertion into the jugular or subclavian vein. We describe a case of hemothorax consequent upon acute dialysis catheter insertion, which resulted in spinal cord infarction and quadriplegia. We postulate that the extensive mediastinal shift induced after insertion of the catheter resulted in stretching of the veins draining the cord with a resultant drop in perfusion pressure and infarction. This case highlights a hitherto unreported complication of this procedure.

Case report of a cervical intraspinal misplacement of a central venous line

“…Neurological complications are extremely rare. In adults, one case of spinal cord infarction after a hemothorax with extensive mediastinal shift and assumed venous affection was reported [2].…”

A delayed diagnosis of a retained guidewire during central venous catheterisation: a case report and review of the literature

“…Some of the most common complications of the CVC are transient arrhythmias, vascular injuries (puncture of the carotid or subclavian artery, perforation of the aorta or SVC, pseudoaneurysms, AV fistulas and vertebral artery),9 pneumothorax, haemothorax or haemomediastinum,10 neurological complications including brachial plexus injury and Horner syndrome11 12 and occasionally retained guidewire or catheter fragments 10 13…”

Revisiting the spectrum of lower motor neuron diseases with snake eyes appearance on magnetic resonance imaging

“…It has also been reported in neuromyelitis optica (Devic's disease) , paraneoplastic myelopathies and Hopkins syndrome . A wide range of ischaemic mechanisms have been linked to the snake eyes sign, including sickle cell disease , decompression sickness , cocaine use , ‘steal’ syndromes secondary to arteriovenous malformations and vasculitis , and also iatrogenic effects, such as intraoperative complications or central‐line insertion . The snake eyes sign has been observed at cervical , thoracic , both cervical and thoracic levels and along the entire spinal cord .…”

“…A wide range of ischaemic mechanisms have been linked to the snake eyes sign, including sickle cell disease [12], decompression sickness [13], cocaine use [14], 'steal' syndromes secondary to arteriovenous malformations [15] and vasculitis [16,17], and also iatrogenic effects, such as intraoperative complications [18] or central-line insertion [19]. The snake eyes sign has been observed at cervical [3,[7][8][9][10][11][12]14,19], thoracic [6,[15][16][17][18], both cervical and thoracic levels [1,4] and along the entire spinal cord [2,5,13]. It is important to distinguish the snake eyes sign from tract-specific changes in corticospinal tracts (suggestive of paraneoplastic myelopathy, B12/copper deficiency etc.)…”