Ghouri Raza Gulzar, Ali Muhammad Mohsin, Naeem Hamza, Raza Maryam Saleem, Arshad Waqas
Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan.
King Edward Medical University, Lahore, Pakistan.
BMJ Neurol Open. 2024 May 22;6(1):e000684. doi: 10.1136/bmjno-2024-000684. eCollection 2024.
Bronchial artery embolization (BAE) is the established first-line treatment for patients presenting with massive haemoptysis, a life-threatening condition that can occur because of numerous underlying diseases. BAE is a relatively safe procedure with control of haemorrhage achieved in 77%-90% of cases and rare occurrence of complications. Spinal cord infarction is one such rare complication, which can have severe implications in terms of morbidity.
We present a case of a 70-year-old man who developed paraplegia with loss of pain and temperature sensation as well as sphincteric involvement following BAE for hemoptysis. MRI of the spine was suggestive of an ischaemic event involving anterolateral spinal cord segment T4-T6, so a diagnosis of anterior spinal artery syndrome post BAE was made. The patient was given corticosteroids, dual antiplatelet medications, pregabalin, supportive management and regular physiotherapy. Follow-up of the patient at 3 and 6 months failed to show any significant improvement in neurological function, although the patient did not report problem of significant hemoptysis afterward.
Spinal cord infarct is a rare and disabling complication of BAE despite it being a safe procedure with good long-term outcomes. Detailed knowledge about the anatomy of bronchial arteries and spinal arteries with detailed preprocedure investigations may lower the risk of this disabling complication.
支气管动脉栓塞术（BAE）是治疗大量咯血患者的既定一线治疗方法，大量咯血是一种因多种潜在疾病可能发生的危及生命的病症。BAE是一种相对安全的手术，77%-90%的病例可实现出血控制，并发症发生率低。脊髓梗死就是这样一种罕见的并发症，可能对发病率产生严重影响。
我们报告一例70岁男性患者，在接受BAE治疗咯血后出现截瘫，伴有痛觉和温度觉丧失以及括约肌受累。脊柱MRI提示缺血性事件累及脊髓胸段T4-T6的前外侧节段，因此诊断为BAE术后前脊髓动脉综合征。给予患者皮质类固醇、双联抗血小板药物、普瑞巴林、支持治疗和定期物理治疗。对患者进行3个月和6个月的随访，神经功能未见明显改善，不过患者此后未再出现大量咯血问题。
尽管BAE是一种安全且长期效果良好的手术，但脊髓梗死是其罕见且致残的并发症。对支气管动脉和脊髓动脉解剖结构的详细了解以及详细的术前检查可能会降低这种致残并发症的风险。
