title: Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma.
abstract: Transcatheter arterial chemoembolization (TACE) has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Sang Jung
authors.initials: SJ
authors.lastname: Park
authors.forename: Chang Ha
authors.initials: CH
authors.lastname: Kim
authors.forename: Jin Dong
authors.initials: JD
authors.lastname: Kim
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Yim
authors.forename: Min Ho
authors.initials: MH
authors.lastname: Seo
authors.forename: Dae In
authors.initials: DI
authors.lastname: Lee
authors.forename: Jun Hyuk
authors.initials: JH
authors.lastname: Kang
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects*; D006509:Hepatitis B / Q000150:complications / Q000188:drug therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012983:Soft Tissue Neoplasms / Q000556:secondary; D013119:Spinal Cord Injuries / Q000209:etiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000998:Antiviral Agents
keywords: Costal metastasis; Hepatocellular carcinoma; Paraplegia; TACE