Complications arising after thoracic aortic surgery: A case report on an unusual spinal cord infarction. Physiopathological and clinical considerations

Abstract

Even though new prevention techniques have been developed and are being used during thoraco-abdominal aortic repairs, spinal cord infarction remains a severe and relatively frequent complication of aortic surgery. Infarctions in the territory of the anterior spinal artery are considered the most common. Different clinical pictures related to spinal cord transverse extension wounds are drawn up. In this paper, we present a case report of a subject having presented an isolated motor deficit of the lower limbs and a favorable prognosis, suggesting selective involvement of the anterior horns of the spinal cord subsequent to surgical repair of an aortic dissection. We wish to review the relevant anatomical, clinical and diagnostic characteristics along with current techniques of spinal cord ischemia prevention during and after surgery.

Unruptured aneurysm with intramural thrombus is an unusual cause of spinal cord infarction: a case report

“…The anterior spinal cord region has a higher rate of spinal cord infarction; this may be because the radiculomedullary arteries in the anterior territory are less numerous than those in the posterior territory [ 2 ].…”

“…The nature and degree of the neurological injury are determined by the infarction's height, its transverse extension, and individual anatomical variances in spinal cord vascularization. The issues may appear acutely, subacutely, or chronically, and the neurological deficiency may appear immediately (as a result of spinal cord hypoperfusion) or later (as a result of protracted hypoxia's repercussions) [2] . When a spinal cord lesion is suspected, the first test that should be done is a spinal MRI.…”

The neuroprotective mechanism of puerarin in the treatment of acute spinal ischemia–reperfusion injury is linked to cyclin-dependent kinase 5

“…Spinal cord ischemia and subsequent paraplegia as a complication are sometime resulted from surgical procedures of the thoracic or thoracoabdominal aorta [1]. Some of strategies for preventing the paraplegia are available [2], but the incidence of paraplegia remains relatively high, and using these therapies as a clinical treatment is greatly challenging [3].…”

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.)…”