Delayed paraplegia associated with vertebral necrosis after type A dissection surgery.
Paraplegia is a rare complication of surgery for acute type A aortic dissection. We report a case of delayed postoperative paraplegia associated with necrosis of the thoracic vertebral bodies and soft tissue. The pathogenesis of delayed postoperative paraplegia is unknown, but our case report would strongly suggest ischemia of the descending thoracic intercostal arteries as the causative mechanism. The precipitating episode (respiratory distress syndrome with hemodynamic instability) might have promoted the compromised spinal circulation to become clinically evident in our patient. Treatment for this serious complication is mostly supportive, although CSF drainage may be helpful in the acute phase.
Department of Cardiac Surgery, Heart Centre Leipzig, Strümpellstrasse 39, 04289 Leipzig,Germany. evagird@centras.lt
Evaldas
E
Girdauskas
Thomas
T
Kuntze
Thomas
T
Walther
Friedrich-Wilhelm
FW
Mohr
D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D004322:Drainage / Q000379:methods; D006801:Humans; D007866:Leg / Q000098:blood supply; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000150:complications; D010264:Paraplegia / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000150:complications*; D013904:Thoracic Vertebrae / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome