Spinal cord infarction post cardiac arrest in STEMI: A potential complication of intra-aortic balloon pump use.

Intra-aortic balloon pump (IABP) is commonly used as a cardiac assist device in various clinical situations: cardiogenic shock, mechanical complications of acute myocardial infarction, high risk percutaneous coronary interventions, coronary artery bypass graft surgery and refractory unstable angina and ventricular arrhythmias as bridge to therapy. Although current data support its safety, there is limited or no support for its efficacy. We present the case of spinal cord infarction after IABP use in a patient who presented with ST elevation myocardial infarction and cardiac arrest and we discuss the potential mechanism of such a devastating complication.

[The Compression Syndrome of Lumbar Arteries - Case Report of a Rare Disease Pattern]. / Das Kompressionssyndrom der Lumbalarterien - Kasuistik eines seltenen Krankheitsbilds.

STUDY DESIGN: We present a monocentric analysis of the lumbar artery compression syndrome (LACS) in the form of a case report. OBJECTIVES: Literature information was collected about the symptoms, diagnosis and treatment of this rare disorder in the context of the existing data. METHODS: The current medical literature includes only one report about three cases of LACS, collected over 20 years in France and Germany. We compared these cases with the experience of the European Vascular Center Aachen-Maastricht. RESULTS: The symptoms of this rare disorder are dominated by reversible, motion-dependent paralysis of the legs. Compression of the right lumbar arteries by muscular fibres or connective tissue is a fundamental cause. CONCLUSION: Surgical treatment, which means decompression of the lumbar arteries via a thoracolaparotomy, is an appropriate therapy with few complications and good long-term results.

Thrombolysis in anterior spinal artery syndrome.

Anterior spinal artery syndrome (ASAS) is often a devastating spinal stroke occurring when the anterior spinal artery or one of its supplying anterior medullary arteries are occluded. The most common causes are arteriosclerosis, dissection of the abdominal aorta, cardiac embolism and degenerative spine disease, and the major risk factors are smoking, hypertension, diabetes and hypercholesterolaemia. The treatment has generally been supportive. We believe thrombolysis should be considered in the acute phase of this condition, and present a case with ASAS who experienced partial recovery after treatment given 4.5 h after symptom onset.

Anterior spinal cord syndrome in a patient with Behçet's disease.

Although neurological involvement in Behçet's disease is not so uncommon, isolated spinal cord disease is quite rare and reported to be observed in about 2% of all cases with neurological involvement. Here we report a Behçet's patient with spinal cord disease presented with anterior spinal cord syndrome. This rare syndrome is caused by hypoperfusion of the anterior spinal artery and to our knowledge has not been previously reported in patients with Behçet's disease. This report defines the characteristic clinical features of this entity and emphasizes the importance of early immunosuppressive treatment and initiation of rehabilitation.

Delayed onset of anterior spinal artery syndrome after repair of aortic coarctation.

STUDY DESIGN: A case report. OBJECTIVE: We report a case of delayed anterior spinal artery syndrome after repair of aortic coarctation in which the symptoms did not appear until 6 months after surgery. SUMMARY OF BACKGROUND DATA: Residual dilatation of the anterior spinal artery after surgery can mimic a dilated intraspinal vein, which could lead to the erroneous diagnosis of spinal arteriovenous malformation as the cause for anterior spinal artery syndrome. METHODS: A 40-year-old man with a history of hypertension underwent surgical bypass of the left subclavian artery to descending thoracic aorta to treat coarctation of the thoracic aorta and had an uncomplicated postoperative course. Six months later, he developed numbness and weakness in his hands. Magnetic resonance image showed abnormal signal within the cervicothoracic spinal cord and prominent flow voids within the ventral spinal canal. Spinal digital subtraction angiography revealed slow flow in a dilated intraspinal vessel. Given the history of aortic coarctation repair, the possibility that this represented a residually dilated anterior spinal artery rather than an arteriovenous malformation was considered and confirmed on magnetic resonance imaging. RESULTS: In our patient, institution of an anticoagulation medication regime resulted in rapid improvement of neurological symptoms, underscoring the importance of the awareness of this phenomenon. CONCLUSION: Delayed anterior spinal artery syndrome after aortic coarctation repair because of anterior spinal artery thrombosis can manifest even 6 months postoperatively. Careful analysis of pre- and postoperative cross-sectional imaging should provide the correct diagnosis. Spinal digital subtraction angiography is probably unnecessary and must be interpreted with caution.

Complex arteriovenous fistulas at C1 causing hematomyelia through aneurysmal rupture of a feeder from the anterior spinal artery.

A 64-year-old woman presented with left occipital headache and right dissociated sensory loss due to hematomyelia on the left ventral side of C1 caused by rupture of an aneurysm on one of the feeders extending from the anterior spinal artery to complex epidural or dural and intradural arteriovenous fistulas (AVFs). Branches from the left occipital and ascending pharyngeal arteries and those from the left C2 radicular, left posterior spinal and anterior spinal arteries formed these multiple shunts, linking with a common venous drain flowing into the right petrosal vein. Surgical interception of all the shunts was achieved, making it unnecessary to directly treat the aneurysm in the spinal cord. The feeders, aneurysm and AVFs were not visualized on postoperative angiography, and the patient returned to a normal working life.

Anterior spinal artery syndrome in a 13-year-old boy 8 days after taekwondo-fight: vascular obliteration due to vessel lesion or thrombophilia?

BACKGROUND: Spinal cord infarction from anterior spinal cord syndrome (ASAS) in children is a rare pathology and comprises the following clinical symptoms: sudden onset of pain and flaccid para- or tetraparesis, bladder dysfunction, and dissociated sensory loss with impairment of pain and temperature perception. Deep sensibility is not affected. PATIENT: A 13-year-old male patient presented to our emergency department with a bilateral leg weakness. 1 week before, he had suffered a leg strain in a Taekwondo-fight from which he recovered completely. On physical examination our patient's legs were in flaccid paralysis, tone was decreased and he had dissociated sensory loss and acute retention of urine. Blood count, ESR, electrolytes, serologic tests for various pathogens and CSF examination all were normal. However, tests for values of an acute endothelial lesion were increased and he was a homozygous carrier of MTHFR-polymorphism. MRI performed on the day of admission was normal but showed dramatic changes 2 days later with increased signal intensity in the ventral aspect of the spinal cord, characteristic for an ASAS. Treatment included highdose methylprednisolone, a suprapubic bladder catheter, sufficient anticoagulation and a rapid transfer to a rehabilitation centre. DISCUSSION: We assume that a combination of the patient's prothrombotic risk factor (MTHFR-polymorphism with elevated homocysteine levels) and his trauma in the taekwondo-fight with consecutive vessel injury caused an occlusion of the artery by late emboli or a growing thrombus.

Occlusion of the artery of Adamkiewicz after hip and knee arthroplasty.

The artery of Adamkiewicz is the most significant tributary of the anterior spinal artery in the midthoracic region; the occlusion of this artery results in a well-described phenomenon consisting of paraplegia with loss of the sensation of pain, temperature, and touch as well as loss of sphincter control. Proprioception and vibration sense are typically preserved. Although this phenomenon has been associated with several surgeries as well as preexisting aortic abnormalities, the literature thus far has not reported this as a complication of hip or knee arthroplasty. Two case histories are presented.

Arnold-Chiari malformation type 1 complicated by sudden onset anterior spinal artery thrombosis, tetraparesis and respiratory arrest.

Chiari in 1891 described a constellation of anomalies at the base of the brain inherited congenitally, the characteristic of which are (1) extension of a tongue of cerebellar tissue posterior to the medulla and cord that extends into the cervical spinal canal; (2) caudal displacement of the medulla and the inferior part of the fourth ventricle into the cervical canal; and (3) a frequent but not invariable association with syringomyelia or a spinal developmental abnormality. Chiari recognized four types of abnormalities. Presently, the term has come to be restricted to Chiari's types I and II, that is, to cerebellomedullary descent without and with a meningomyelocele, respectively. The association of Arnold-Chairi malformation and high cervical cord infarction is unusual. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischaemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, postsurgical, sepsis, hypotension and thromboembolic disorders. The authors present an interesting case of cervical cord infarction due to anterior spinal artery thrombosis in a patient of type 1 Arnold-Chiari malformation without any of the above predisposing factors.

Neurological symptoms after a provocative dive: spinal DCS or anterior spinal artery syndrome?

Reported here is a 37-yr-old professional diving instructor who had developed complaints of back pain and weakness in the lower extremities after diving. He was eventually diagnosed as having spinal cord decompression sickness along with a likely diagnosis of anterior spinal artery (artery of Adamkiewicz) syndrome. Additionally, since the transthoracic echocardiography revealed patent foramen ovale, we hypothesized that it might have been a potential route for gas bubbles to occlude the anterior spinal artery in this diver.

Infarto medular cervical extenso por herniaciónde un disco intervertebral / Extensive spinal cord infarction due to a herniated intervertebral disk

El síndrome de la arteria espinal anterior posee una etiología muy variada por lesiones secundarias a cuadros hemorrágicos e isquémicos que afectan a la porción anterior dela médula espinal. La presencia de dolor difuso o radicular con pérdida de la sensibilidad superficial y conservación de la sensibilidad propioceptiva y vibratoria, junto a paraparesiay pérdida del control de esfínteres a nivel infralesional es la clínica típica del cuadro. Se presenta el caso de un varón de 39 años que presenta de forma súbita cervicobraquialgiae instauración en pocas horas de tetraplejia con compromiso respiratorio. Las pruebas de imagen demostraron la existencia de hernia de disco posterolateralcervical e infarto medular cervical extenso. Se describe la posible etiología, patogenia y la relación entre el infarto espinal y la herniación de un disco intervertebral (AU)

Anterior spinal artery syndrome may be caused by a variety of events, such as lesions secondary to bleeding and ischemia affecting the anterior portion of the spinal cord. The usual clinical picture involves diffuse or radicular pain below the level of the lesion, with loss of sensitivity on the surface but preservation of proprioception and sensitivity to vibration, plus paraparesis and loss of sphincter control. We report the case of a 39-year-old man who developed sudden neck pain radiating to the arm within a few hours of suffering tetraplegia with compromised airways. Images showed a herniated posterolateral cervical disk and extensive infarction of the cervical spinal cord. The possible causes of anterior spinal artery syndrome, including the relationship between spinal infarction and a herniated intervertebral disk, are discussed (AU)

Role of diffusion MRI in diagnosis of spinal cord infarction in children.

Anterior spinal artery (ASA) infarction is a rare but well-described cause of flaccid paraparesis in adults, presenting with a high thoracic spinothalamic sensory level and preservation of dorsal column function. Careful sensory examination, demonstrating loss of spinothalamic modalities with preservation of dorsal column modalities, supports a clinical diagnosis of ASA infarction. Findings on conventional MRI of the spinal cord are often non-specific, and diffusion-weighted imaging (DWI) is not routinely performed. We describe four children with ASA infarction after minor trauma. DWI was performed in all cases and confirmed the clinical diagnosis.

Lesión de aorta abdominal secundaria a trauma cerrado / Abdominal aorta injury secondary to closed trauma

La lesión traumática de la aorta abdominal con interrupción total del flujo sanguíneo es infrecuente. Cuando se produce la obstrucción total de la arteria el cuadro clínico es dramático. El mecanismo más frecuente es la compresión por el cinturón de seguridad durante un accidente automovilístico. Los pacientes se encuentran con pulsos femorales y distales ausentes, asociado a neuropatía en extremidades inferiores. Presentamos un caso de lesión de aorta abdominal secundaria a trauma cerrado y repasamos las causas, formas de presentación y manejo de la lesión

Traumatic injury of the abdominal aorta with total interruption of blood flow is uncommon. When there is total obstruction of the artery, the clinical picture is dramatic. The most frequent mechanism is compression due to the safety belt during a car accident. The patients have absent femoral and distal pulses, associated to neuropathy in the lower limbs. We present a case of abdominal aorta injury secondary to closed trauma and review the causes, presentation forms and management of the injury