Paraparesis caused by transarterial chemoembolization: A case report

Abstract

Transarterial chemoembolization (TACE) is an effective modality for the treatment of Hepatocellular Carcinoma. It is used to treat small tumors and to downstage large tumors to meet liver transplant criteria. TACE can be associated with multiple side effects, including fever, right upper quadrant pain, nausea, vomiting, hepatic failure, hepatic encephalopathy, cholecystitis and pancreatitis. Neurological complications after TACE are rare, usually caused by cerebral embolism, and confirmed by means of imaging studies. Spinal cord ischemia secondary to TACE is extremely rare and can lead to significant morbidity. We report a case of paraparesis caused by TACE with normal imaging and nerve conduction studies, suggestive of localized vasculitis.

Spinal Cord Ischemia Secondary to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

“…Spinal cord injury after TACE usually occurs after the second or third session, which can be explained by hepatic artery injury or decreased flow at the previous TACE site, leading to collateral recruitment [ 4 ]. Sometimes it may result from the inadvertent embolization of spinal branches arising from intercostal or lumbar collateral vessels [ 9 , 11 ].…”

“…Sometimes it may result from the inadvertent embolization of spinal branches arising from intercostal or lumbar collateral vessels [ 9 , 11 ]. The clinical symptoms and signs of spinal cord injuries usually manifest about 6–8 h after the procedure as paresthesias, impaired sensory function, parapareses or paraplegias and urinary retention [ 4 , 9 ]. MRI findings are usually normal in the acute phase, but hyperintensities on T2-weighted images and focal cord enlargement are expected after 1–2 days, followed even later by cord enhancement after gadolinium administration.…”

“…Neurological deficits after TACE are very rare and usually due to lipoidal embolism in the central nervous system. Spinal cord injury is an extremely rare complication after TACE and can lead to significant morbidity [ 4 ]. Here, we report a rare case of paraplegia that occurred after TACE to treat HCC, and review the previous literature.…”

Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma

“…TACE is a palliative treatment method, which treats cancer by injecting an embolic material with anticancer agents through supplying arteries of tumors, and it has been reported to improve the survival of patients with advanced HCC 3. However, TACE demands special attention as it may cause not only a well-known post-infarction syndrome of high fever, right upper abdominal pain, and nausea in about 2.9% of cases,4 but also various other complications, resulting from unintended embolization of the normal liver or extrahepatic organs including the gall bladder, pancreas, lung, brain, and spinal cord 5. In particular, neurologic adverse events such as cerebral infarction or paraplegia, although being rare, might leave severe sequelae with permanent disability, and require an immediate and effective treatment 5-8.…”

“…However, TACE demands special attention as it may cause not only a well-known post-infarction syndrome of high fever, right upper abdominal pain, and nausea in about 2.9% of cases,4 but also various other complications, resulting from unintended embolization of the normal liver or extrahepatic organs including the gall bladder, pancreas, lung, brain, and spinal cord 5. In particular, neurologic adverse events such as cerebral infarction or paraplegia, although being rare, might leave severe sequelae with permanent disability, and require an immediate and effective treatment 5-8. However, on their treatment process and prognosis, no well documented and detailed information is available.…”