Ischemia-reperfusion injury is a rare but serious complication encountered after spinal decompression surgery. This is only the 11th case reported in the literature. There is no current mainstay of treatment; however, several therapies have been studied. This case presents a patient with myelomalacia who underwent posterior laminectomy and developed diffuse cord edema with postoperative quadriplegia. Ischemia-reperfusion injury is believed to be mediated by oxidative and nitrosative stress leading to protein degradation and lipid peroxidation. It is characterized by myelomalacia in a chronically ischemic spinal cord and hyperintensity on T2-weighted MRI after decompression. Treatment has involved steroids and rehabilitation, and outcomes have ranged from minor improvement to full recovery. Novel treatment options have shown promise in animal models.

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Background: Approximately one-fourth of admissions to stroke centers are diagnosed with non-stroke conditions or stroke mimics. Differentiating between these diagnoses and acute ischemic stroke is an important and time-sensitive task. The decision of whether or not to administer thrombolytic therapy is also a critical component, and its safety has been studied numerous times. Case Report: This case presents a patient with pneumococcal meningitis initially diagnosed as an acute ischemic stroke treated with thrombolytic therapy before further imaging. Conclusion:Many stroke mimics such as migraines, infections, and seizures exist. Time is of the essence for the treatment of an acute ischemic stroke. The safety profile of tissue plasminogen activator has been studied numerous times in stroke mimics and shown to be relatively safe indicating if the patient has no contraindications for stroke intervention, treatment of stroke should not be extensively delayed to rule out stroke confounders.

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Pregnancy in a patient with Marfan syndrome is associated with risks, including cardiovascular complications. The hemodynamic changes of pregnancy during delivery are deleterious to Marfan syndrome patients. This case describes a Marfan syndrome parturient with dilated aortic root >45 mm who underwent neuraxial anesthesia and cesarean delivery. Anesthetic management focused on reducing hypertension and shear forces on the ascending aorta. A combined spinal-epidural with a reduced dose of hyperbaric bupivacaine was utilized for cesarean delivery. Multidisciplinary approaches are vital in the management of Marfan syndrome pregnancy and cardiovascular complications must be considered when planning for delivery and postpartum management. Anesthetic management must consider the hemodynamic changes in pregnancy and severity of Marfan syndrome cardiovascular involvement in the parturient as well as neonatal risks. Guideline development concerning anesthetic management for both the timing of delivery and aortic repair postpartum would be beneficial to Marfan syndrome parturients.