Hypotensive spinal cord infarction associated with vertebral body infarction after treatment with short-acting antihypertensive agent.
Spinal cord infarction is a rare condition with heterogeneous causes. An 80-year-old diabetic woman was brought to the emergency department because of retrosternal pain and high blood pressure. Twenty minutes after treatment with sublingual nitroglycerin and short-acting oral antihypertensive agent, blood pressure had dropped from 201/91 mm Hg to 158/68 mm Hg, followed by abrupt onset of weakness in lower limbs, urinary retention and sensory loss in bilateral T4-L1 levels and the left lower limb at two hours after treatment. Magnetic resonance imaging showed contrast-enhanced and high-intensity lesions in the mid and lower thoracic cord, which were consistent with ischemic changes within the spinal cord and in the T4 vertebral body. After rehabilitation therapy for 2 months, she became able to ambulate with the aid of a walker. To reduce the risk of hypotensive sequelae such as spinal cord infarction, blood pressure should be closely monitored in elderly patients presenting with retrosternal chest pain who are treated with short-acting oral antihypertensive agent, particularly when additional risk factors such as atherosclerosis, diabetes mellitus or hypertension are present.
Huang
Tai-Chung
TC
Department of Internal Medicine, National Taiwan University Hospital, Taipei.
Hwang
Juey-Jen
JJ
Yip
Ping-Keung
PK
Liu
Hon-Man
HM
D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007238:Infarction / Q000139:chemically induced*; D013116:Spinal Cord / Q000098:blood supply*; D013131:Spine / Q000098:blood supply*
D000959:Antihypertensive Agents