Neurological complications of extraspinal.

The anatomy and physiology of the blood supply to the central nervous system from the aorta is outlined. Pertinent cases are reported, to illustrate the effect of impairment of this blood supply in producing ischemia of the brain, spinal cord, and peripheral nerves. In patients with such neurologic disease, especially if sudden in onset, a search for a circulatory basis in lesions of the aorta or its branches may be rewarding and crucial. With regard to reconstructive surgery of the aorta, certain precautions may be taken: maintenance of normotension, gentle dissection, preservation of segmental arteries when possible, bypass shunting, avoidance of prolonged aortic clamping and perhaps heparinization. Unfortunately, depending upon deficiencies in collateral circulation to the spinal cord, occasional cases of postoperative paraplegia will still occur, which are both unavoidable and unpredictable.