Shin Beomsu, Cho Yang Hyun, Choi Jin-Ho, Yang Jeong Hoon
Department of Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Acute Crit Care. 2018 Aug;33(3):187-190. doi: 10.4266/acc.2016.00556. Epub 2018 Aug 31.
Spinal cord infarction is an uncommon, but serious disorder characterized by severe motor impairment and bladder and bowel dysfunction. Spinal cord infarction is likely caused by hypoperfusion at the thoraco-lumbar spinal cord due to diverse reasons. An 81-year-old woman without motor or neurologic dysfunction presented with cardiogenic shock due to acute myocardial infarction. We performed veno-arterial extracorporeal membrane oxygenation (VA ECMO) to maintain adequate organ perfusion. Lower limb weakness was noted on day 1 of ECMO support. Although the symptom persisted, we could not carry out further evaluation because of her hemodynamic instability. After removal of ECMO, spinal magnetic resonance imaging was performed and showed a signal abnormality extending from the level of T5 to the conus medullaris. The patient underwent conservative management, but eventually experienced limb paralysis. Herein, we report a case of spinal cord infarction in a patient with myocardial infarction during VA ECMO support.
脊髓梗死是一种罕见但严重的疾病，其特征为严重的运动障碍以及膀胱和肠道功能障碍。脊髓梗死可能由多种原因导致的胸腰段脊髓灌注不足引起。一名81岁无运动或神经功能障碍的女性因急性心肌梗死出现心源性休克。我们进行了静脉-动脉体外膜肺氧合（VA ECMO）以维持足够的器官灌注。在ECMO支持的第1天发现下肢无力。尽管症状持续存在，但由于她的血流动力学不稳定，我们无法进行进一步评估。撤除ECMO后，进行了脊髓磁共振成像检查，结果显示从T5水平至脊髓圆锥有信号异常。患者接受了保守治疗，但最终出现肢体瘫痪。在此，我们报告1例在VA ECMO支持期间发生心肌梗死的患者出现脊髓梗死的病例。
