Takebayashi Kento, Shiwa Tomoko, Ishikawa Tomomi, Taira Takaomi, Kawamata Takakazu
Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
Heliyon. 2020 Sep 7;6(9):e04869. doi: 10.1016/j.heliyon.2020.e04869. eCollection 2020 Sep.
Spinal cord infarction is reported to account for less than 1% of all strokes and is a relatively rare disease. In recent years, thoracic endovascular aortic repair (TEVAR) has become a common treatment for aortic aneurysms, and spinal cord ischemia is one of its complications. Most cases occur in the perioperative period; however, a few cases have been reported in the chronic stage. Here, we report a case of spinal cord infarction, 6 months after TEVAR. A 77-year-old man experienced sudden onset paraparesis following dumbbell exercises and defecation. He had a history of an infectious thoracoabdominal aortic aneurysm treated by TEVAR 6 months prior. Paralysis and disturbance of the thermal pain and tactile sensations of the lower limbs were observed, but proprioception and deep sensation were preserved. Computed tomography (CT) showed no evidence of intraspinal hemorrhage, new aortic dissection, or endoleak around the aortic stent placed from Th11 to L3. Magnetic resonance imaging (MRI) showed intramedullary hyperintensity from Th11 to the conus 2 days after onset. Anticoagulant therapy and rehabilitation were performed, and the lower-limb muscle strength gradually improved. After aortic stenting, particularly including the level of the Adamkiewicz artery, the risk of spinal cord ischemia must be monitored, because spinal circulation depends on collateral circulation.
据报道，脊髓梗死占所有中风病例的比例不到1%，是一种相对罕见的疾病。近年来，胸段血管腔内主动脉修复术（TEVAR）已成为治疗主动脉瘤的常用方法，脊髓缺血是其并发症之一。大多数病例发生在围手术期；然而，也有少数慢性期病例的报道。在此，我们报告一例TEVAR术后6个月发生脊髓梗死的病例。一名77岁男性在进行哑铃运动和排便后突然出现双下肢轻瘫。他有6个月前因感染性胸腹主动脉瘤接受TEVAR治疗的病史。观察到下肢麻痹以及热痛觉和触觉障碍，但本体感觉和深感觉保留。计算机断层扫描（CT）未显示脊髓内出血、新的主动脉夹层或从胸11至腰3置入的主动脉支架周围内漏的迹象。发病2天后，磁共振成像（MRI）显示胸11至圆锥髓内高信号。进行了抗凝治疗和康复治疗，下肢肌肉力量逐渐改善。主动脉支架置入后，尤其是包括Adamkiewicz动脉水平，必须监测脊髓缺血风险，因为脊髓循环依赖于侧支循环。
