Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome

Abstract

Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl’s eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.

SERPINE1 Gene Is a Reliable Molecular Marker for the Early Diagnosis of Aortic Dissection

“…Serum amylase has been reported to be increased when plasma cavity hematoma is present, or when the superior mesenteric artery is involved and involves the pancreas [ 40 , 41 ]. Hematuria has also been reported in the presence of renal involvement, and hemorrhagic cerebrospinal fluid is reported in the presence of stroke [ 42 , 43 ]. Once the dissection ruptures, the patient may die of massive hemorrhage within a few hours.…”

Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection

“…Out of 19 patients having undergone emergency surgery, full recovery in 13 patients, residual paraplegia in 4 patients, and death in 2 patients was observed. The overall mortality was 57.14% in patients presenting with SCI in the setting of ATAAD [23]. Two patients developed SCI in our study and both of them were discharged, one without recovery and the other with a partial recovery from paraplegia.…”

“…Spinal cord ischemia in ATAAD is also a rare condition, and little data are available on its incidence [23]. Spinal cord ischemia presents as anterior spinal cord syndrome in 87.2% of cases, while SCI in the territory of the posterior spinal artery is very rare [24].…”

Prevention of Spinal Cord Injury during Thoracoabdominal Aortic Aneurysms Repair: What the Anaesthesiologist Should Know

“…Ensuring blood flow to the left subclavian and femoral artery via extracorporeal circulation during circulation arrest and guaranteeing hypothermia are techniques used to prevent SCI during aortic arch repair [ 74 ]. Intraoperative CSF drainage is not currently recommended due to emergency surgery, but it can be useful postoperatively to treat sudden paraplegia, according to data of aortic aneurysm repair [ 75 ]. Not-complicated type-B dissection requires a first step conservative treatment with medical therapy and rest.…”