Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction

Cheung, Albert T.; Weiss, Stuart J.; McGarvey, Michael L.; Stecker, Michael S.; Hogan, Michael S; Escherich, Alison; Bavaria, Joseph E.

doi:10.1016/s0003-4975(02)03714-1

Cited by 144 publications

(80 citation statements)

References 21 publications

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“…Cases with acute neurologic events were subjected to further NIHSS and ASIA exams along with a detailed neurologic consultation and examination along with appropriate neuroimaging to confirm the existence of spinal or brain ischemia and exclude peripheral nerve or muscle injury. If an episode of spinal ischemia was detected intraoperatively or postoperatively, our institution's standard protocol was followed to attempt to reverse ongoing ischemia (Cheung et al, 2002(Cheung et al, , 2005McGarvey etal., 2007).…”

Section: Experimental Procedures Surgical Proceduresmentioning

confidence: 99%

Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest

et al. 2008

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Previously, we identified 14-3-3 β and ζ isoforms and proteolytic fragments of α-spectrin as proteins released from degenerating neurons that also rise markedly in cerebrospinal fluid (CSF) following experimental brain injury or ischemia in rodents, but these proteins have not been studied before as potential biomarkers for ischemic central nervous system injury in humans. Here we describe longitudinal analysis of these proteins along with the neuron-enriched hypophosphorylated neurofilament H (pNFH) and the deubiquitinating enzyme UCH-L1 in lumbar CSF samples from 19 surgical cases of aortic aneurysm repair, 7 involving cardiopulmonary bypass with deep hypothermic circulatory arrest (DHCA). CSF levels of the proteins were near the lower limit of detection by Western blot or enzyme-linked fluorescence immunoassay at the onset of surgical procedures, but increased substantially in a subset of cases, typically within 12-24 hours. All cases involving DHCA were characterized by >3-fold elevations in CSF levels of the two 14-3-3 isoforms, UCH-L1, and pNFH. Six of 7 also exhibited marked increases in α-spectrin fragments generated by calpain, a protease known to trigger necrotic neurodegeneration. Among cases involving aortic cross-clamping but not DHCA, the proteins rose in CSF preferentially in the subset experiencing acute neurological complications. Our results suggest the neuron-enriched 14-3-3β, 14-3-3ζ, pNFH, UCH-L1, and calpain-cleaved α-spectrin may serve as a panel of biomarkers with clinical potential for the detection and management of ischemic central nervous system injury, including for mild damage associated with surgically-induced circulation arrest.

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Section: Experimental Procedures Surgical Proceduresmentioning

confidence: 99%

Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest

et al. 2008

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“…Many factors can play a role in this complication, including systemic hypotension before, during, or after the procedure, aortic cross clamping resulting in decreased arterial perfusion and increased spinal canal pressure, and occlusion of important feeding arteries such as the artery of Adamkiewicz or other intercostal arteries owing to ligation, resection, or embolization. Episodes of systemic hypotension in many cases appear to be temporally associated with delayed onset of ischemia (6,7). During surgery, the presented patient was not hypotensive or tachycardic.…”

Section: Discussionmentioning

confidence: 77%

“…Coarctation of the aorta and its surgical repair is a less common cause of SCI (4). SCI following thoracic aortic surgery can be clinically apparent immediately following surgery or after a period of normal neurologic functioning (6). Delayed spinal cord ischemia has been reported as late as postoperatively at 27 days (7).…”

Section: Discussionmentioning

confidence: 99%

Postoperative Acute Ischemic Spinal Cord Infarction without Vertebral Fracture in Children

Poyrazoğlu¹,

Serhatlıoğlu²,

Per³

et al. 2016

Erciyes Med J

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Anterior spinal artery infarction is extremely rare in children; it is caused by the hypoperfusion of the anterior spinal artery, leading to ischemia. Patients typically present with acute paraparesis or quadriparesis, depending on the level of spinal cord involvement. In general, it is clinically diagnosed, and neuroimaging is used to confirm the diagnosis and exclude other conditions. There are only a few reports in the pediatric literature characterizing the etiology, diagnosis, treatment, and prognosis of spinal cord infarction. It is associated with moderate-to-severe disabilities and a high mortality rate. Here we report an unusual case wherein a 12-month-old male developed spinal cord infarction following surgery to repair the coarctation of the aorta. Spinal magnetic resonance imaging showed bilateral hyperintensity corresponding to the anterior horns of grey matter in the conus.

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“…8). This speculation is supported by the clinical consequence that delayed-onset paraplegia could be successfully reversed by reducing CSF pressure (Cheung et al, 2002). Fig.…”

Section: Clinical Siginificance Of Cerebrospinal Fluid Drainagementioning

confidence: 86%

Prevention of Spinal Cord Injury After Thoracoabdominal Aortic Aneurysm Repair

Kunihara¹,

Kubota²,

Wakasa³

et al. 2011

Diagnosis and Treatment of Abdominal and Thoracic Aortic Aneurysms Including the Ascending Aorta and the Aortic Arch

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Interventions for reversing delayed-onset postoperative paraplegia after thoracic aortic reconstruction

Cited by 144 publications

References 21 publications

Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest

Biomarker evidence for mild central nervous system injury after surgically-induced circulation arrest

Postoperative Acute Ischemic Spinal Cord Infarction without Vertebral Fracture in Children

Prevention of Spinal Cord Injury After Thoracoabdominal Aortic Aneurysm Repair

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