scholarly journals Anterior Spinal Cord Syndrome is a Complication Following Embolisation of Bleeding Intercostal Artery in Penetrating Trauma: A Case Report

2020 ◽  
Author(s):  
Tovi Vo ◽  
Daniel Harris ◽  
Ngee Foo ◽  
Daniel Eillis
Keyword(s):  
Spinal Cord ◽  
Trauma Patient ◽  
Penetrating Trauma ◽  
Intercostal Artery ◽  
Spinal Cord Infarction ◽  
Contrast Extravasation ◽  
Transcatheter Arterial Embolisation ◽  
Arterial Embolisation ◽  
Artery Of Adamkiewicz ◽  
The Right

Abstract Background:Transcatheter arterial embolisation of intercostal vessels is a minimally invasive procedure that is increasingly being used in the management of haemothorax in the trauma patient, however significant complications – such as spinal ischaemia can occur. We present a rare case of paralysis in a patient following embolisation of the intercostal arteries due to bleeding from penetrating trauma.Case presentation:A 46-year-old male presented to the Emergency department with two stab wounds to the right posterior chest. Computed tomography scan of the chest revealed active contrast extravasation from the right 9th intercostal artery. Selective embolisation of the right 9th intercostal artery using Gelfoam® and coils as well as further embolisation of the 7th, 8th and 10th intercostal arteries was performed. Unfortunately due to ongoing bleeding and hypotension, the patient subsequently required emergency surgery that revealed two penetrating injuries to the right inferior lobe of the lung. After the patient was extubated, he was found to have bilateral motor from the level of L4 and below and sensory deficits from L2 and below. Magnetic resonance imaging of the spine showed spinal cord infarction at the level of T11 and T12 that was thought to be secondary to the embolisation of the intercostal arteries inadvertently affecting the artery of Adamkiewicz.Conclusions:Transcatheter arterial embolisation has an established roll in haemostasis of the trauma patient – particularly in intercostal arteries for the management of haemothorax. Although extremely rare, spinal complications from this procedure can be significantly life changing for the patient. The variable anatomy of the artery of Adamkiewicz should be carefully considered on a case-by-base basis in the stable trauma patient and balance of risk versus benefit be determined if the artery is unable to be identified on pre-procedure angiography.

scholarly journals Spinal Cord Infarction from an Unstable Aortic Plaque

2011 ◽  
Vol 38 (1) ◽  
pp. 145-146
Author(s):  
Jamsheed A. Desai ◽  
Nicola Gambarotta
Keyword(s):  
Spinal Cord ◽  
Conus Medullaris ◽  
Acute Onset ◽  
Spinal Cord Infarction ◽  
Sensory Level ◽  
Aortic Plaque ◽  
Artery Of Adamkiewicz ◽  
Magnetic Resonance Imaging Mri ◽  
T2 Hyperintensity ◽  
The Right

A 78 year-old woman presented with acute onset low back pain with radiation into the right T12-L2 dermatomes, progressive flaccid paraparesis, urinary incontinence and bilateral lower extremity paresthesias. Examination revealed flaccid paraparesis, and a T12 sensory level to pin with intact vibration and proprioception. Magnetic resonance imaging (MRI) (Figure 1) of the spinal cord demonstrated T2 hyperintensity and restricted diffusion from T12 to the conus medullaris. Computed tomogram (CT) aortogram (Figure 2) highlighted an ulcerated plaque and thrombus at the approximate level of the artery of Adamkiewicz. These findings were consistent with a spinal cord infarct of the cord from T12-L2. The patient was treated with Clopidogrel and IV heparin (x two days) and was transferred for spinal cord rehabilitation.

Isolated giant true intercostal artery aneurysm with arteriovenous fistula: A case report

Vascular ◽  
2021 ◽  
pp. 170853812110413
Author(s):  
Kenichi Honma ◽  
Terutoshi Yamaoka ◽  
Daisuke Matsuda
Keyword(s):  
Minimally Invasive ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Artery Aneurysm ◽  
Rare Condition ◽  
Intercostal Artery ◽  
Spinal Cord Infarction ◽  
Invasive Treatment ◽  
Intercostal Artery Aneurysm ◽  
The Right

Objectives Intercostal artery aneurysm (IAA) is a very rare condition. Interestingly, only one study reported a case of intercostal aneurysm caused by an arteriovenous fistula (AVF). Here, we report the case of a patient with non-ruptured isolated giant true IAA caused by an AVF (size, 28 × 41 mm). Methods Treatment options for IAA include open surgery and endovascular treatment (EVT). We chose EVT, as it is minimally invasive. The right 11th intercostal artery and aneurysm diverged from the aorta. Two outflow arteries, one inflow artery, and an AVF from the aneurysm were confirmed, and coil embolization was performed. The artery of Adamkiewicz did not communicate with the right 11th intercostal artery. We performed angiography and confirmed occlusion of IAA with endoleak. Results There were no clinical findings indicative of spinal cord infarction after treatment. The patient did not develop complications and was discharged the day after treatment. Endoleak was not observed on computed tomography angiography findings at 1 month after treatment. Conclusions In our patient, an AVF might have caused IAA. Endovascular treatment for non-ruptured isolated giant IAA is a safe and minimally-invasive treatment. We found that performing EVT is beneficial when the size of the IAA exceeds 30 mm.

Gunshot wound causing anterior spinal cord infarction due to injury to the artery of Adamkiewicz

2016 ◽  
Vol 16 (9) ◽  
pp. e603-e604 ◽  
Author(s):  
David Phillips ◽  
Sanjay S. Dhall ◽  
Alina Uzelac ◽  
Jason F. Talbott
Keyword(s):  
Spinal Cord ◽  
Gunshot Wound ◽  
Spinal Cord Infarction ◽  
Artery Of Adamkiewicz

Paraplegia following thoracolumbar sympathectomy

1971 ◽  
Vol 34 (4) ◽  
pp. 569-571 ◽  
Author(s):  
Ronald F. Shallat ◽  
Thomas E. Klump
Keyword(s):  
Spinal Cord ◽  
Anterior Spinal Artery ◽  
Intercostal Artery ◽  
Spinal Cord Infarction ◽  
Content Type ◽  
Fine Print

✓ A case is presented in which a bilateral thoracolumbar sympathectomy and splanchnicectomy were followed by permanent paraplegia below T-10. The hypothesis is presented that coagulation of a bleeding intercostal vessel during surgery led to a propagating thrombus which involved, successively, the intercostal artery, a segmental medullary vessel, and the anterior spinal artery with resulting spinal cord infarction. Other possible mechanisms are mentioned. Several technical suggestions are offered with regard to prevention of this complication.

scholarly journals REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients

2020 ◽  
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Fernando Rodriguez ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
New Technology ◽  
Management Strategies ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Hemostatic Resuscitation ◽  
The Right ◽  
Trauma Surgeons

Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

The angiosome territories of the spinal cord: exploring the issue of preoperative spinal angiography

2008 ◽  
Vol 8 (4) ◽  
pp. 352-364 ◽  
Author(s):  
Michael K.-Y. Hong ◽  
Matthew K.-H. Hong ◽  
Wei-Ren Pan ◽  
David Wallace ◽  
Mark W. Ashton ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Collateral Circulation ◽  
Vascular Occlusion ◽  
Senior Author ◽  
Spinal Tumors ◽  
Spinal Cord Infarction ◽  
Spinal Angiography ◽  
Oxide Mixture ◽  
Thoracolumbar Region ◽  
Artery Of Adamkiewicz

Object The angiosome concept has been the subject of extensive research by the senior author (G.I.T.), but its specific applicability to the spinal cord was hitherto unknown. The aim of this study was to see if the spinal cord vasculature followed the angiosome concept and to review the usefulness of preoperative spinal angiography in surgery for spinal disorders. Spinal cord infarction and permanent paraplegia may result from inadvertent interruption of the artery of Adamkiewicz. Spinal angiography, which may enable avoidance of this catastrophic complication, is still not commonly used. Methods Two fresh cadavers were injected with a gelatin–lead oxide mixture for detailed comparative study of spinal cord vasculature. One cadaver had insignificant vascular disease, whereas the other had extensive aortic atherosclerosis, presenting a unique opportunity for study. After removal from each cadaver, radiographs of the spinal cords were obtained, then photographed, and the vascular territories of the cords were defined. Results Four angiosome territories were defined: vertebral, subclavian, posterior intercostal, and lumbar. These vascular territories were joined longitudinally by true anastomotic channels along the anterior and posterior spinal cord. Anastomosis between the anterior and posterior vasculature was poor in the thoracolumbar region. The anterior cord relied on fewer feeder arteries than the posterior, and the anterior thoracolumbar cord depended on the artery of Adamkiewicz for its supply. In chronic aortic disease with intercostal artery occlusion at multiple levels, a rich collateral circulation supporting the spinal cord was found. Conclusions The arterial supply of the spinal cord follows the angiosome concept. The atherosclerotic specimen supports the suggestion that the blood supply is able to adapt to gradual vascular occlusion through development of a collateral circulation. Nevertheless, the spinal cord is susceptible to ischemia when faced with acute vascular occlusion. This includes inadvertent interruption of the artery of Adamkiewicz. The authors recommend the use of preoperative spinal angiography to prevent possible paraplegia in removal of thoracolumbar spinal tumors.

Microsurgical Management of a Spinal Dural Arteriovenous Fistula With Shared Blood Supply to the Artery of Adamkiewicz: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (6) ◽  
pp. E174-E175 ◽  
Author(s):  
C Michael Cawley ◽  
Brian M Howard ◽  
Daniel L Barrow
Keyword(s):  
Spinal Cord ◽  
Lower Extremity ◽  
Arteriovenous Fistula ◽  
Blood Supply ◽  
Dural Arteriovenous Fistula ◽  
Spinal Cord Infarction ◽  
Thoracic Myelopathy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Artery Of Adamkiewicz

Abstract The presented case is of a 65-yr-old gentleman referred for thoracic myelopathy. He developed bilateral, nondermatomal foot dysesthesia 14 mo prior to presentation, which progressed to numbness below the L3 level. He reported progressive gait instability, bilateral lower extremity weakness, and required a cane for ambulation. He subsequently developed urinary incontinence, while bowel function was spared. The neurological examination upon presentation revealed lower extremity strength was reduced to 4/5 in all major muscle groups bilaterally, while sensation and proprioception were reduced below the L3 level. Patellar and Achilles reflexes were not elicited and clonus was absent. Gait was unsteady and slow. The patient was not able to perform heel, toe and tandem gait. MRI revealed abnormal T2 hyper-intense signal and spinal cord expansion from T6 through the conus medullaris. Angiography revealed a dural arteriovenous fistula (dAVF) originating from the left T9 radicomedullary pedicle, which also supplied the Artery of Adamkiewicz (AoA). The patient underwent T8-10 laminectomies. Prior to disconnection of the fistula, an aneurysm clip was applied to the fistulous point and an indocyanine green video angiogram was completed to show that the fistula no longer opacified, but that the AoA remained patent, which was later confirmed with angiography. As of discharge, the patient's motor exam had improved substantially, though his sensory deficits persisted. This case demonstrates that surgical disconnection is requisite in the treatment of spinal dAVF that have a shared blood supply with the AoA, as embolization risks spinal cord infarction.  The patient consented to presentation of this case in a de-identified fashion.

scholarly journals P.095 Holey Spinal Cord - A case of spinal cord stroke secondary to fibrocartilaginous embolism

2018 ◽  
Vol 45 (s2) ◽  
pp. S41-S41
Author(s):  
S Wasyliw ◽  
P Masiowski
Keyword(s):  
Spinal Cord ◽  
Transverse Myelitis ◽  
Professional Sports ◽  
Spinal Cord Infarction ◽  
Fibrocartilaginous Embolism ◽  
Unsteady Gait ◽  
Spinal Cord Infarct ◽  
History Of ◽  
Bone Infarct ◽  
The Right

Background: Fibrocartilaginous embolism (FCE) is a rare reported cause of spinal cord infarction and likely underdiagnosed due to clinical unfamiliarity. FCE can present after a mild trauma and is characterized by back or neck pain along and a rapidly progressive myelopathy. We present a case of FCE and discuss how this clinical entity can break the typical rules of stroke. Methods: Case presentation Results: An otherwise healthy, 56-year-old professional sports coach presented a couple day history of progressive leg paresthesias and mild back pain, followed by unsteady gait and then inability to void. The left leg demonstrated mild weakness, hyperreflexivity, ataxia and an upgoing plantar response. The right leg became spastic and he then developed bilateral impairment of vibration and proprioception at the toes. An initial limited MRI lumbar spine was negative. A repeat MRI spine showed mild diffusion restriction of T10-11 and T11-12 and evidence of a bone infarct L2. He was diagnosed with a spinal cord infarct secondary to FCE. Conclusions: FCE should be considered in the differential for acute myelopathy. It can present with a progressive nature like transverse myelitis and MRI may be non-diagnostic. As more cases are being reported, FCE is becoming better defined and recognized.

scholarly journals Chronic type B aortic dissection complicated by repetitive spinal cord ischaemia

2020 ◽  
Vol 31 (5) ◽  
pp. 745-747
Author(s):  
Masato Fujimoto ◽  
Hirohisa Murakami ◽  
Hiroshi Tanaka
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
False Lumen ◽  
Spinal Cord Infarction ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Chronic Type ◽  
Spinal Cord Ischaemia ◽  
The Right ◽  
Segmental Arteries

Abstract Chronic type B aortic dissection complicated by repetitive transient spinal cord ischaemia is rare. Reduced blood flow in the segmental arteries supplying the radicular arteries in the false lumen is the main cause of this pathology. Individual variations in spinal cord circulation are difficult to identify; therefore, the mechanisms of spinal cord ischaemia are poorly understood. We encountered a patient with chronic type B aortic dissection experiencing repetitive spinal cord ischaemia that finally led to spinal cord infarction. The patient recovered, except for mild monoparesis of the right leg. With the growth of the dissected aorta, we planned for surgical treatment to restore the blood supply in the spinal cord. The patient underwent thoraco-abdominal aortic repair using deep hypothermia, and favourable neurological results were achieved.

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