Abdominal Aortic Aneurysm Manifested by Transient Spinal Cord Ischemia: a Case Report / 日本心臓血管外科学会雑誌

We report an extremely rare case of an abdominal aortic aneurysm with transient spinal cord ischemia. A 64-year-old male patient presented with a sudden onset of paralysis upon waking up. He was admitted to the emergency department with bilateral lower extremity paralysis. Computed tomography and ultrasonography were performed, and the findings revealed an aneurysmal dilatation. The maximum aneurysm diameter was 65×62 mm. In addition, there was a mural thrombus that was located on the posterior aspect of the wall of the aneurysmal dilatation, and part of the mural thrombus was liquefied. After admission to the hospital, although the symptoms of spinal cord ischemia began to improve, melena was observed the following day. He was subsequently diagnosed with ischemic colitis by an emergency colonoscopy. The mural thrombus had dispersed into the lumbar and internal iliac arteries, and it was postulated that this had been the cause of the spinal cord ischemia and ischemic colitis. Due to an improvement in the spinal cord ischemia and ischemic colitis, he underwent abdominal aortic replacement two weeks later. Spinal cord ischemia and ischemic colitis resolved without recurrence, and he was discharged 13 days post-operatively.

The Neuroprotective Effects of Ginsenoside Rd Pretreatment in a Rat Model of Spinal Cord Ischemia-Reperfusion Injury

ABSTRACT Introduction: Paraplegia may develop as a result of spinal cord ischemia-reperfusion injury in patients who underwent thoracoabdominal aortic surgery. The objective of this research is to determine the neuroprotective effects of ginsenoside Rd pretreatment in a rat model of spinal cord ischemia-reperfusion injury. Methods: Sprague-Dawley rats (n=36) were randomly assigned to three groups. The sham (n=12) and control (n=12) groups received normal saline orally. The Rd group (n=12) received ginsenoside Rd (100 mg/kg) orally 48 hours before the induction of spinal cord ischemia. Spinal cord ischemia was induced by aortic occlusion using a Fogarty balloon catheter in the Rd and control groups. A neurological assessment according to the motor deficit index and a histological evaluation of the spinal cord were performed. To evaluate the antioxidant activity of ginsenoside Rd, malondialdehyde levels and superoxide dismutase activity were determined. Further, the tissue levels of tumor necrosis factor-alpha and interleukin-1 beta were measured. Results: The Rd group showed significantly lower motor deficit index scores than did the control group throughout the entire experimental period (P<0.001). The Rd group demonstrated significantly greater numbers of normal motor neurons than did the control group (P=0.039). The Rd group exhibited decreased malondialdehyde levels (P<0.001) and increased superoxide dismutase activity (P=0.029) compared to the control group. Tumor necrosis factor-alpha and interleukin-1 beta tissue levels were significantly decreased in the Rd group (P<0.001). Conclusion: Ginsenoside Rd pretreatment may be a promising treatment to prevent ischemia-reperfusion injury in patients who undergo thoracoabdominal aortic surgery.

Successful Management of Acute Type A Aortic Dissection with Spinal Cord Ischemia: A 3-Case Series / 日本心臓血管外科学会雑誌

Spinal cord ischemia (SCI), a complication of acute aortic dissection, has no established treatment. Here, we report the successful management of three cases of acute type A aortic dissection (ATAAD) with SCI using a multidisciplinary approach. Case 1: A 55-year-old man presented with paraparesis due to ATAAD (non-communicating type), cardiac tamponade, and no loss of consciousness. He underwent emergency surgery for ascending aortic replacement. He awoke 3 h after the surgery; however, as his paralysis was not improved, we initiated multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy. These treatments led to the complete resolution of his symptom; he was discharged on Day 32, with no neurological deficits. Case 2: A 50-year-old woman presented with complete paralysis of the left lower limb due to ATAAD (communicating type) but no loss of consciousness. She underwent emergency surgery for ascending aortic replacement. She awoke 2 h after the surgery; however, as her paralysis was not improved, multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy were initiated, which led to partial resolution of the symptoms. She could walk with orthotics and was discharged on Day 57. Case 3: A 43-year-old man presented with paraparesis of the left lower limb due to ATAAD (non-communicating type). He was hemodynamically stable, with no loss of consciousness. The ATAAD was conservatively managed, and multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy was administered. These therapies led to the complete resolution of his symptoms; he was discharged on Day 46, with no neurological deficits. Hence, for ATAAD with SCI, multidisciplinary treatment, including emergency surgery, is an important therapeutic strategy.

Recent advance in role of ubiquitin-specific protease 11 in central nervous system diseases / 中华神经医学杂志

Ubiquitin-specific protease 11 (USP11) is a family member of deubiquitylases (DUBs). It mediates substrates de-ubiquitination to inhibit their ubiquitin-proteasome degradation and participates in cell cycle process, DNA damage repair, cell death, autophagy, signal transduction, immune inflammatory response, cerebral cortex development, and other physiological processes. Studies show that USP11 also plays an important role in central nervous system diseases. This article starts with the structure and functions of USP11 to systematically review the mechanism of USP11 in central nervous system diseases and provide new ideas for USP11 as a therapeutic target.

Acute Paraplegia Result from Spinal Ischemia Nine Years After Hybrid Total Arch Repair with Frozen Elephant Trunk: A Case Report

ABSTRACT Spinal cord ischemia due to decreased cord perfusion is a devastating complication in patients with thoracoabdominal dissection following frozen elephant trunk (FET) repair surgery. However, rare occurrence of spinal cord ischemia leading to paraplegia after long-term follow-up of FET repair has been reported. Here, we describe a case of spinal cord ischemia resulting in paraplegia nine years after hybrid total arch repair with FET. Cerebrospinal fluid drainage and serial treatment were utilized to decrease intraspinal pressure and increase blood flow to the spinal cord. Three months after the onset of paraplegia and with treatment and rehabilitation, the patient recovered to walk.

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report

Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Comparison between arch zones in modified frozen elephant trunk procedure for complex thoracic aortic diseases

Abstract Introduction: The aim of this study is to compare postoperative outcomes and follow-up of two different modifications facilitating surgical technique of frozen elephant trunk (FET) procedure for complex thoracic aortic diseases - zone 0 (fixation with total arch debranching) and zone 3 (fixation with islet-shape arch repair). Methods: From May 2012 to December 2018, data were collected from 139 patients who had been treated with FET procedure for complex thoracic aortic diseases. According to Ishimaru arch map, patients with proximal anastomotic site of hybrid graft at zone 0 and zone 3 were grouped as Group A (n=58, 41.7%) and Group B (n=81, 58.3%), respectively. Mean age of study population was 54.7±11.4 years, and 111 patients were male (79.9%). Results: In-hospital mortality was observed in 20 (14.4%) patients (n=12, acute type A aortic dissection, and n=4, previous aortic dissection surgery). There was no significant difference between both groups in terms of in-hospital mortality. Four patients from Group A and three patients from Group B had permanent neurological deficit (P=0.32). Three patients from both groups had transient spinal cord ischemia (P=0.334). Although mean total perfusion time was longer in Group A, duration of visceral ischemia, when compared with Group B, was shorter (P<0.001). Five-year survival rate was 82.8% in Group A and 81.5% in Group B (P=0.876). Conclusion: FET procedure is a feasible repair technique in the treatment of complex aortic diseases, providing satisfactory early results. Because of its advantageous aspects, zone 0 fixation with debranching is the preferred technique in our clinic.

Protection of spinal cord ischemia-reperfusion injury mediated by N-methyl-D-aspartate receptors / 中国胸心血管外科临床杂志

@#Objective    To analyze the protective mechanism of spinal cord ischemia-reperfusion injury mediated by N-methyl-D-aspartate (NMDA) receptor. Methods    A total of 42 SD rats were randomly assigned to 4 groups: a non-blocking group (n=6), a saline group (n=12), a NMDA receptor blocker K-1024 (25 mg/kg) group (n=12) and a voltage-gated Ca2+ channel blocker nimodipine (0.5 mg/kg) group (n=12). The medications were injected intraperitoneally 30 min before ischemia. The neural function was evaluated. The neuronal histologic change of spinal cord lumbar region, the release of neurotransmitter amino acids and expression of spinal cord neuronal nitric oxide synthase (nNOS) were compared. Results    At 8 h after reperfusion, the behavioral score of the K-1024 group was 2.00±0.00 points, which was statistically different from those of the saline group (5.83±0.41 points) and the nimodipine group (5.00±1.00 points, P<0.05). Compared with the saline group and nimodipine group, K-1024 group had more normal motor neurons (P<0.05). There was no significant difference in glutamic acid concentration in each group at 10 min after ischemia (P=0.731). The nNOS protein expression in the K-1024 group was significantly down-regulated compared with the saline group (P<0.01). After 8 h of reperfusion, the expression of nNOS protein in the K-1024 group was significantly up-regulated compared with the saline group (P<0.05). Conclusion    K-1024 plays a protective role in spinal cord ischemia by inhibiting NMDA receptor and down-regulating nNOS protein expression; during the reperfusion, K-1024 has a satisfactory protective effect on spinal cord function, structure and biological activity of nerve cells.

Could cerebrospinal fluid biomarkers offer better predictive value for spinal cord ischaemia than current neuromonitoring techniques during thoracoabdominal aortic aneurysm repair - a systematic review

Abstract Objective: Cerebrospinal fluid (CSF) drainage is a technique that has significantly reduced the incidence of spinal cord ischaemia (SCI). We present results of a systematic review to assess the literature on this topic in relation to thoracoabdominal aortic aneurysm repair (TAAR). Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR. Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8. Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker.

Effects of ligustrazine on autophagy-related proteins after spinal cord ischemia-reperfusion injury / 国际中医中药杂志

Objective To investigate the effect of ligustrazine on autophagy-related proteins Beclin 1,LC3 and P62 after spinal cord ischemia-reperfusion injury.Methods A total of 48 SD rats were randomly divided into sham operation group,model group,ligustrazine group and 3-MA group.The rats were intraperitoneally injected with ligustrazine injection 0.16 mg/kg in the Ligustrazine group,the rats were intraperitoneally injected with 3-methyladenine injection 0.015 mg/kg in the inhibitor group,and the rats were intraperitoneally injected with normal saline of equal volume in the sham operation group and model group.Spinal cord ischemia-reperfusion model was established in all groups except sham-operated group after administration.After molding behavioral scores were scored after 3 and 6 hours of ischemia,and the expression of Beclin 1,LC3 and P62 was detected by immunohis-tochemistry.Results After 3 and 6 hours,compared with the model group,the behavioral score (3 h:2.33 ± 0.58 vs.0.67 ± 0.58,6 h:3.33 ± 0.58 vs.1.33 ± 0.58) of the rats in ligustrazine group significantly increased (P＜0.05).Compared with the model group,the expression of Beclinl (3 h:348.00×104± 0.27×104 vs.659.00×104± 0.11×104;6 h:38.00×104± 0.19×104 vs.557.00×104± 0.26×104),LC3 (3 h:357.00×104± 0.48×104 vs.686.00×104± 0.33×104'6 h:334.00×104± 0.51×104 vs.673.00×104 ± 0.22×104),P62 (3 h:357.00×104 ± 0.48×104 vs.830.00×104 ± 0.48×104;6 h:315.00×104 ± 0.12× 104 vs.591.00× 104± 0.36× 104) in ligustrazine group were significantly decreased (P＜0.05).Conclusions The ligustrazine may regulate autophagy in two directions and protect nerve cells.

Effects of ginsenoside Rg1 on survivin protein expression and apoptosis in rats with spinal cord ischemia-reperfusion injury / 西安交通大学学报(医学版)

Objective: To observe the effects of ginsenoside Rg1 pretreatment on the expression of survivin protein and apoptosis after spinal cord ischemia-reperfusion injury (SCII) in rats so as to explore the possible mechanism of ginsenoside Rg1 on motor function recovery after SCII in rats. Methods: We selected 120 adult healthy SD rats to construct the model of SCII and randomly divided them into four groups: sham operation group, ischemia group, ischemia-reperfusion group, and drug group. Basso Beattie and Bresnahan score (BBB score) was used to evaluate the motor function of the hind limbs of the rats. The expressions of survivin protein and apoptosis-inducing factor (AIF) was observed by immunohistochemistry. The expression and activity of survivin protein and Caspase-9 in each group were observed and analyzed by Western blot and RT-PCR. Results: The intervention of ginsenoside Rg1 could increase the score of the motor function of the rat hind limbs. It could decrease the number of AIF positive cells, but increase the number of survivin protein positive cells. Ginsenoside Rg1 could decrease the expressions of survivin and Caspase-9, and decrease the apoptosis of nerve cells in SCII. Conclusion: Ginsenoside Rg1 could inhibit the expression of Caspase-9 by promoting the expression of survivin protein and decrease the apoptosis of rat SCII induced by the level of cytoplasmic AIF.

Effects of autophagy of lipoxin A4 on spinal cord ischemia-reperfusion injury in rats / 医学研究生学报

Objective　Lipoxin A4 (LXA4) has been proved to have a good protective effect on spinal cord ischemia-reperfusion injury in rats, but whether autophagy is one of the protective mechanisms remains unclear. This study aims to investigate the effects of lipoxin A4 on rat spinal cord ischemia-reperfusion injury.　Methods　48 rats were randomly divided into LXA4 group, ischemia-reperfusion group (SCII group) and sham group with 16 rats in each, and the models of each group were built accordingly. The rats in LXA4 group received intrathecal injection of 10μl LXA4 (300 pmol) 30 minutes after clamping the abdominal aorta. Three groups of rats were sacrificed by cervical dislocation 24 hours after reperfusion and the apoptosis-positive cells were then obtained. The spinal cord tissues of three groups of rats were stained and counted by LC3B fluorescence staining, and the expressions of LC3-II/LC3-I and GABARAP protein were detected by Western blot.　Results　There were few LC3B positive cells in the sham group. Compared to those in the sham group (73.40±19.42), the number of LC3B positive cells in SCII group (399.80±18.46) and LXA4 group (240.80±12.76) significantly increased (P<0.05), and the number in LXA4 group was significantly lower than that in SCII group (P<0.05). The ratio of LC3-II/LC3-I and the expression of GABARAP in SCII group and LXA4 group was significantly higher than those in sham group (P<0.05). The ratio of LC3-II/LC3-I in spinal cord tissue significantly declined compared with that of SCII group (P<0.05).　Conclusion　The autophagy is activated when SCII occurs, indicating that the autophagy is involved in SCII. After LXA4 is administered, autophagy is inhibited and SCII is alleviated.

Nursing experience of a patient with secondary catheter complications caused by cerebrospinal fluid drainage after endovascular aorticrepair / 中国实用护理杂志

Objective To summarize the nursing experience of a patient with secondary catheter complications caused by cerebrospinal fluid drainage after endovascular aorticrepair. Methods A retrospective analysis was made on the clinical situation of a patient who received cerebrospinal fluid drainage afterendovascular aorticrepair in 2017, and the cause of secondary catheter complications, symptoms and signs were identified and nursing. Results After careful observation, mean arterial pressure maintenance, painmanagement, cerebrospinal fluid drainage velocity management, catheter infection risk and control, psychological intervention and exercise rehabilitation, the patient was finally recovered and discharged. Conclusions In order to evaluate the postoperative complications, we should not only focus on the surgery but also on the adverse events caused by cerebrospinal fluid drainage. In addition,we should improve the ability to identify the source of problems, to risk management and to disease assessment.

Vertebral Artery Dissection Presenting with Acute Infarction in Cervical Spinal Cord and Cerebellum

We describe a case of vertebral artery dissection (VAD) presenting with acute infarctions in cervical spinal cord and cerebellum in a 78-year-old man. Diffusion-weighted magnetic resonance (MR) imaging of the brain demonstrated diffusion-restricted lesions in the right cerebellum and sagittal T2-weighted MR imaging of spinal cord showed a hyperintense lesion of the cervical spinal cord at C2-C4 level. Right VAD was identified by transfemoral cerebral angiography and computed tomography angiography which showed segmental occlusion in the right vertebral artery.

Conus Medullaris Syndrome Due to Posterior Spinal Artery Infarction

A 77-year-old female with a history of osteoarthritis visited our clinic complaining of lower back pain, paresthesia in both legs, and voiding difficulty. Her pain and temperature sensations were diminished below the L1 dermatome, and proprioception was decreased in both feet. The findings of a routine laboratory workup, echocardiogram, and cerebrospinal fluid studies were normal. Spine magnetic resonance imaging revealed high T2-weighted signal intensities and diffusion restriction in the posterior conus medullaris. The patient was diagnosed and treated for posterior spinal artery infarction.

Surfer's Myelopathy: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a rare cause of non-traumatic spinal cord injury (SCI) during surfing SUMMARY OF LITERATURE REVIEW: Surfer's myelopathy is a non-traumatic SCI associated with the hyperextension posture during paddling in surfing. Although the definite pathomechanism has not been identified, cord ischemia followed by arterial infarction may be related to this injury. MATERIALS AND METHODS: A young healthy male patient presented with a SCI that occurred during his first time surfing. Magnetic resonance imaging revealed a T2-hyperintense lesion in the spinal cord from D10 to the conus medullaris. RESULTS: The patient completely recovered without any neurologic deficits after steroid therapy and other forms of supportive management. CONCLUSIONS: Since surfing is becoming more common in Korea, awareness of surfer's myelopathy is important for early diagnosis and proper management.

Spinal cord infarction mimicking ischemic heart disease

Spinal cord infarction is a rare condition and is easily misdiagnosed owing to its initial non-specific manifestation. We report a case of a 77–year-old man who presented with chest pain and upper back pain initially, and was misdiagnosed with a myocardial infarction. Four hours after admission, he complained of numbness in his entire left leg below the knee, with rapid deterioration of neurological symptoms. After 9 hours, loss of sensation progressed up to the T4 dermatome, strength of both lower extremities deteriorated to grade 0, and decrease in anal tone and deep tendon reflex was observed. Initial magnetic resonance imaging findings were normal; however, a signal change occurred 3 days after symptom onset. When patients present with acute chest pain and neurologic symptoms, the possibility of ischemic cardiac disease as well as any neurological manifestations must be investigated. Emergency physicians must remember the value of serial physical examinations.

Myelopathy Caused by Surfing

No abstract available.

Perfusion of gastrodin in abdominal aorta for alleviating spinal cord ischemia reperfusion injury

Objective To observe the effects of perfusion of the gastrodin in abdominal aorta for alleviating the spinal cord ischemia reperfusion injury (SCIRI). Methods A total of 36 New Zealand white rabbits were divided randomly into sham-operated group (group S), control group (group C) and gastrodin group (group G), 12 rabbits for each group. Aorta abdominalis infrarenalis blocking method was applied to establish the SCIRI model. The changes of motor evoked potentials (MEPs) before the ischemia and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of the gastrodin were respectively recorded, and the neurologic function score before the ischemia, on the 6 h, 12 h and 24 h of the reperfusion of the gastrodin were assessed. And the changes of the concentration of serum neuron specific enolase (NSE), interleukin (IL)-lβ and IL-8 were measured before the ischemia, after 45 min of ischemia, and on 30 min, 60 min, 6 h, 12 h and 24 h of reperfusion of gastrodin. Then the levels of spinal cord nerve cells mitochondrial superoxide dismutase (SOD), reactive oxygen species (ROS), glutathione peroxidase (GSH-PX), malondialdehyde (MDA), total antioxidant capacity (T-AOC) and mitochondrial swelling degree (MSD) were tested and the histopathologic changes in spinal cord tissues were observed. Results The levels of the NSE, IL-lβ, IL-8, ROS, MDA and MSD of group C were all significantly elevated after the ischemia (P < 0.01); the levels of the spinal nerve cell mitochondria SOD, GSH-PX and T-AOC were all significantly reduced (P < 0.01), MEPs and spinal cord tissue pathology were damaged significantly (P < 0.01). The rate of motor neuron abnormalities and the damages of spinal cord tissue pathology of group G were significantly milder than those of group C (P < 0.01); the levels of NSE, IL-lβ, IL-8, ROS, MDA and MSD were significantly lower than those of group C (P < 0.01), but the levels of SOD, GSH-PX and T-AOC were all significantly higher than those of group C (P < 0.01), and the recovery of neurologic function score during the reperfusion of gastrodin was significantly faster than group C (P < 0.01). Conclusions Perfusion of the gastrodin in abdominal aorta can alleviate the spinal cord ischemia reperfusion injury by promoting the mitochondrial antioxidant capacity and inhibiting the inflammatory reaction.

Spinal cord ischemia following endovascular repair of infrarenal abdominal aortic aneurysm: A retrospective analysis / 第二军医大学学报

Objective To explore the morbidity and possible mechanism of spinal cord ischemia (SCI) after infrarenal abdominal aortic aneurysm (IAAA) endovascular aneurysm repair (EVAR). Methods We retrospectively analyzed the intraoperative hypogastric artery occlusion and postoperative SCI of 400 patients who received EVAR in the Departments of Vascular and Endovascular Surgery of Shanghai Changhai Hospital and Changzheng Hospital from January 2008 to October 2014. The morbidity and possible mechanism of SCI after EVAR were analyzed while combining the existing literatures. Results Bilateral hypogastric arteries were obstructed during operation in 60 patients (unilateral hypogastric artery aneurysms were embolized by spring coil in 8 cases); unilateral hypogastric arteries was obstructed in 70 patients (unilateral hypogastric artery aneurysms were partially embolized by spring coil in 10 cases). Postoperatively 2 cases had acute lower limb artery ischemia, 1 had acute SCI, and 1 had chronic lower limb lameness(> 3 months). The incidence of SCI was 0. 25% (1/400). Existing literatures showed that the incidence of SCI following EVAR was 0. 21%-0. 38%, and only 1 of the 14 cases with SCI was thought to be associated with the hypogastric artery— interruption. Conclusion SCI is a very rare postoperative complication of EVAR, with the mechanism remaining unknown. The occlusion of hypogastric artery may play a part, but existing literatures suggest a noncore role. In addition to ischemia caused by SCI and embolization, the perioperative general condition of patients also needs to be taken into consideration.