Haidari Aghigh, Sabzi Feridoun, Dabiri Samsam
Department of Cardiovasculary Surgery, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Acta Med Iran. 2017 Dec;55(12):807-811.
Paraplegia is an exceedingly rare neurologic complication after off-pump coronary artery bypass graft (OPCAB) surgery commonly caused by spinal cord ischemia (SCI). SCI is not a well unknown clinical phenomenon in the postoperative course. SCI has been reported after noncardiac surgery in otherwise healthy subjects in whom only one risks factor i.e. severe hypotension has been documented. SCI has also been reported as a rare complication among the other neurologic sequels of cardiac surgery. We report a case of paraplegia in a patient with metabolic syndrome and multiples risk factors after an OPCAB. This patient may be considered as an interesting case as no any ischemic event was found in the imaging modalities and culprit lesion may be attributed to 1-left internal thoracic artery use as an important blood perfusion to anterior spinal artery vasculature and 2-Disc herniation at intervertebral space of T as a culprit lesion 3-transient intraoperative hypotension. The patient was managed by lower extremities physiotherapy and skin care, however, after 3months of follow-up, no evidence of recovery was detected.
截瘫是非体外循环冠状动脉搭桥术（OPCAB）后极为罕见的神经并发症，通常由脊髓缺血（SCI）引起。SCI在术后病程中并非鲜为人知的临床现象。在其他方面健康的受试者进行非心脏手术时，曾有SCI的报道，其中仅记录到一个危险因素，即严重低血压。SCI也作为心脏手术其他神经后遗症中的罕见并发症被报道过。我们报告一例在接受OPCAB后患有代谢综合征和多种危险因素的患者发生截瘫的病例。该患者可能被视为一个有趣的病例，因为在影像学检查中未发现任何缺血事件，罪魁祸首病变可能归因于：1. 使用左胸廓内动脉作为脊髓前动脉血管系统的重要血液灌注；2. T节段椎间隙椎间盘突出作为罪魁祸首病变；3. 术中短暂性低血压。该患者接受了下肢物理治疗和皮肤护理，然而，经过3个月的随访，未发现恢复迹象。
