Lower limb paralysis from ischaemic neuropathy of the lumbosacral plexus following aorto-iliac procedures

Abdellaoui, Adel; West, Nick J.; Tomlinson, Mark; Thomas, Martin; Browning, Neil

doi:10.1510/icvts.2007.151993

Cited by 24 publications

(19 citation statements)

References 5 publications

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“…In previous studies, some patients recovered from spinal cord dysfunction following CSF drainage; these patients usually had incomplete neurological damage, with no spinal cord infarction detected on magnetic resonance imaging. 3,8,13,15 However, complete paralysis with obvious spinal cord infarction, similar to that observed in our case, is considered irreversible.…”

Section: Discussionsupporting

confidence: 85%

“…4,7 The collateral blood supply via the pelvic circulation is important in cases where the Adamkiewicz artery is occluded. 5,[8][9][10] Documented porcine models show that the interaction of the subclavian and median sacral artery is roughly equivalent to the hypogastric arteries in humans, with segmental vessels providing the spinal cord blood supply. 10 In TAAA patients, most of the intercostal and lumbar arteries are occluded, and spinal cord perfusion depends on an effi cient collateral network which includes the lumbar arteries and pelvic circulation.…”

Section: Discussionmentioning

confidence: 99%

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Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: Report of a case

et al. 2009

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This report presents an extremely rare case of paraplegia following emergency surgery for a nonruptured symptomatic abdominal aortic aneurysm. A 62-year-old man underwent an emergency surgical repair for a symptomatic nonruptured infrarenal abdominal aortic aneurysm. On postoperative day 2 paraplegia following spinal cord ischemia occurred at the T8 level. The site of the ischemia was situated too high for clamping to have caused this condition, unless the patient had a congenital anomaly in the blood supply to the spinal cord or it had been caused by the previously occluded great radicular artery, which was maintained by the collateral blood supply from the iliac circulation.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: Report of a case

et al. 2009

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“…7,10 By looking at the outcome of the 6 type 4 lesions that we found, only 1 patient showed complete recovery, and all other patients needed aid to walk (3 of 6) or mobilized in a wheelchair (2 of 6). 1,3,7 Our patient also showed only minimal improvement and needed aid to walk short distances and a wheelchair for mobilization outside his room.…”

Section: Discussionmentioning

confidence: 80%

“…The major problem with this type of complication is that its occurrence and recovery are difficult to predict and that the site of the lesion is often difficult to locate. 1 To fully understand the pathophysiology of ischemic spinal cord and lumbar plexus injuries, one must understand its vascularization. There are 3 spinal arteries originating from the vertebral arteries: 1 anterior, supplying the anterior two third of the cord and 2 posterior, supplying the posterior one third of the cord ( Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Unilateral Lower Limb Paralysis After Aortobifemoral Bypass Graft for Ruptured Abdominal Aortic Aneurysm: A Case Report

Deylgat

Wallaert

Smul

et al. 2009

Vasc Endovascular Surg

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An 81-year-old man underwent an aortobifemoral bypass graft because of a ruptured abdominal aortic aneurysm. His postoperative recovery was complicated by unilateral lower limb paralysis caused by perioperative ischemia of the lumbosacral plexus. Ischemic lumbosacral plexopathy is an uncommon complication after infrarenal aortic surgery with serious morbidity.Despite a good surgical technique and knowledge of the vascularization of the spinal cord, its occurrence remains unpredictable.An 81-year-old man was urgently referred to the emergency services by his treating physician because of acute abdominal pain, mainly in the left flank. On admission, he was pale and suffered from hypotension (blood pressure 50/30 mm Hg). A computerized tomography (CT) was performed, which showed a ruptured juxtarenal abdominal aortic aneurysm. The patient was rushed to the operating room, where an aortobifemoral bypass was performed. There was a suprarenal clamp time of 25 minutes. As nefroprotection rescuvolin (folic acid) and lysomucil (acetylcysteine) were given. There were no important periods of hypotension perioperatively, despite the need for massive transfusion (2 L of autotransfusion, 8 units of packed cells, 4 units of fresh frozen plasma, and 2 pools of thrombocytes, perioperatively). The patient was extubated the same day. The next morning, he complained of hypoesthesia and paresis of his right leg. We also noticed rising of his serum creatinine and urea levels and a potassium level of 6.5 mmol/L (3.5-5.1 mmol/L). Glucose and insulin were started to correct the potassium level, and a subclavian dialysis catheter was used for dialysis. After a few days, potassium, creatinine, and urea levels normalized and all therapies were stopped, but the paralysis and paresthesia of the right limb remained. A CT scan of the brain ruled out any central etiology and an electromyogram (EMG) confirmed peripheral pathology (combined drop foot and plantar flexion paralysis) and our diagnosis of ischemic lumbar plexopathy. Magnetic resonance imaging (MRI) of the lumbar spine 3 weeks postoperative was negative. When the patient was discharged, limited mobilization was possible with aid. DiscussionLower limb paralysis following aortoiliac procedures is a known but rare complication. The overall neurologic risk of endovascular and open infrarenal abdominal aortic surgery ranges between 0% and 1%. 1 The risk is higher for emergency cases (1.4-2%) than for elective cases 2 (0.1-0.2%) and consists of central cord, lumbosacral, and peripheral nerve From the Department of Vascular and Thoracic Surgery, AZ Groeninge Kortrijk, Belgium.

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“…A wide range of pathologies can afflict the lumbosacral plexus including traumatic, congenital, autoimmune, inflammatory, and neoplastic conditions. Patients with these conditions most commonly present with a combination of motor weakness, sensory loss, and pain …”

Section: Introductionmentioning

confidence: 99%

MR Imaging of the Lumbosacral Plexus: A Review of Techniques and Pathologies

Neufeld

Shen

Nidecker

et al. 2015

Journal of Neuroimaging

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The lumbosacral plexus is a complex anatomic area that serves as the conduit of innervation and sensory information to and from the lower extremities. It is formed by the ventral rami of the lumbar and sacral spine which then combine into larger nerves serving the pelvis and lower extremities. It can be a source of severe disability and morbidity for patients when afflicted with pathology. Patients may experience motor weakness, sensory loss, and/or debilitating pain. Primary neurologic processes can affect the lumbosacral plexus in both genetic and acquired conditions and typically affect the plexus and nerves symmetrically. Additionally, its unique relationship to the pelvic musculature and viscera render it vulnerable to trauma, infection, and malignancy. Such conditions are typically proceeded by a known history of trauma or established pelvic malignancy or infection. Magnetic resonance imaging is an invaluable tool for evaluation of the lumbosacral plexus due to its anatomic detail and sensitivity to pathologic changes. It can identify the cause for disability, indicate prognosis for improvement, and be a tool for delivery of interventions. Knowledge of proper MR protocols and imaging features is key for appropriate and timely diagnosis. Here we discuss the relevant anatomy of the lumbosacral plexus, appropriate imaging techniques for its evaluation, and discuss the variety of pathologies that may afflict it.

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Lower limb paralysis from ischaemic neuropathy of the lumbosacral plexus following aorto-iliac procedures

Cited by 24 publications

References 5 publications

Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: Report of a case

Paraplegia following the emergency surgical repair of a nonruptured symptomatic abdominal aortic aneurysm: Report of a case

Unilateral Lower Limb Paralysis After Aortobifemoral Bypass Graft for Ruptured Abdominal Aortic Aneurysm: A Case Report

MR Imaging of the Lumbosacral Plexus: A Review of Techniques and Pathologies

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