title: Delayed onset of anterior spinal artery syndrome after repair of aortic coarctation.
abstract: METHODS
  A case report.
  
  
  OBJECTIVE
  We report a case of delayed anterior spinal artery syndrome after repair of aortic coarctation in which the symptoms did not appear until 6 months after surgery.
  
  
  BACKGROUND
  Residual dilatation of the anterior spinal artery after surgery can mimic a dilated intraspinal vein, which could lead to the erroneous diagnosis of spinal arteriovenous malformation as the cause for anterior spinal artery syndrome.
  
  
  METHODS
  A 40-year-old man with a history of hypertension underwent surgical bypass of the left subclavian artery to descending thoracic aorta to treat coarctation of the thoracic aorta and had an uncomplicated postoperative course. Six months later, he developed numbness and weakness in his hands. Magnetic resonance image showed abnormal signal within the cervicothoracic spinal cord and prominent flow voids within the ventral spinal canal. Spinal digital subtraction angiography revealed slow flow in a dilated intraspinal vessel. Given the history of aortic coarctation repair, the possibility that this represented a residually dilated anterior spinal artery rather than an arteriovenous malformation was considered and confirmed on magnetic resonance imaging.
  
  
  RESULTS
  In our patient, institution of an anticoagulation medication regime resulted in rapid improvement of neurological symptoms, underscoring the importance of the awareness of this phenomenon.
  
  
  CONCLUSIONS
  Delayed anterior spinal artery syndrome after aortic coarctation repair because of anterior spinal artery thrombosis can manifest even 6 months postoperatively. Careful analysis of pre- and postoperative cross-sectional imaging should provide the correct diagnosis. Spinal digital subtraction angiography is probably unnecessary and must be interpreted with caution.
authors.affiliation: Department of Radiology, Division of Neuroradiology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. michael.wilder@hsc.utah.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wilder
authors.forename: Perry P
authors.initials: PP
authors.lastname: Ng
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D020759:Anterior Spinal Artery Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000925:Anticoagulants / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000002:abnormalities / Q000601:surgery*; D001017:Aortic Coarctation / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D013348:Subclavian Artery / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants