Paraplegia After Off-Pump Coronary Artery By-Pass Grafting
Paraplegia is an exceedingly rare neurologic complication after off-pump coronary artery bypass graft (OPCAB) surgery commonly caused by spinal cord ischemia (SCI). SCI is not a well unknown clinical phenomenon in the postoperative course. SCI has been reported after noncardiac surgery in otherwise healthy subjects in whom only one risks factor i.e. severe hypotension has been documented. SCI has also been reported as a rare complication among the other neurologic sequels of cardiac surgery. We report a case of paraplegia in a patient with metabolic syndrome and multiples risk factors after an OPCAB. This patient may be considered as an interesting case as no any ischemic event was found in the imaging modalities and culprit lesion may be attributed to 1-left internal thoracic artery use as an important blood perfusion to anterior spinal artery vasculature and 2-Disc herniation at intervertebral space of T as a culprit lesion 3-transient intraoperative hypotension. The patient was managed by lower extremities physiotherapy and skin care, however, after 3months of follow-up, no evidence of recovery was detected.
Gottesman MH, Saraya I, Tenti F. Modified Brown-Sequard syndrome following coronary artery bypass graft: case report. Paraplegia 1992;30:178-804 .
Singh U, Silver JR, Welply NC. Hypotensive infarction of the spinal cord. Paraplegia 1994;32:314-22.
Saxena P, Hasan FA, Merry C. Spinal cord ischemia following coronary artery bypass surgery. J Card Surg 2012;27:45-6.
Wong C. Paraplegia after coronary artery bypass operations: relationship to severe hypertension and vascular disease. J Thorac Cardiovasc Surg 2000;119:1295-6.
Hirose H, Akhrass R. Tetraplegia after coronary artery bypass, a rare complication. Ann Thorac Cardiovasc Surg 2005;11:270-2.
Thomas NJ, Harvey AT. Paraplegia after coronary artery bypass operations: relationship to severe hypertension and vascular disease. J Thorac Cardiovasc Surg 1999;117:834-6.
Rose DM, Jacobowitz IJ, Acinapura AJ, Cunningham JN Jr. Paraplegia following percutaneous insertion of an intra-aortic balloon. J Thorac Cardiovasc Surg 1984; 87:788-9 .
Seifert PE. Late paraplegia resulting from intra-aortic balloon pump. Ann Thorac Surg 1986;41:700 .
Scott IR, Goiti JJ. Late paraplegia as a consequence of intra-aortic balloon pump support. Ann Thorac Surg 1985;40:300-1 .
Tyas DH, Willman VL. Paraplegia following intra-aortic balloon assistance. Ann Thorac Surg 1987;25:164-6.
Bondurant FJ, Cotler HB, Kulkarni MV, McArdle CB, Harris JH Jr. Acute spinal cord injury: a study using physical examination and magnetic resonance imaging. Spine 1990;15:630-8 .
Scherr K, Urquhart G, Eichorst C, Bulbuc C. Paraplegia after coronary artery bypass graft surgery: case report of a rare event. Crit Care Nurse 2006;26:34-6, 38-40, 42-5 .
Deem S, Shapiro HM, Marshall LF. Quadraplegia in a patient with cervical spondylosis after thoracolumbar surgery in the prone position. Anesthesiology 1991;75:527-8 .
Hirose H, Akhrass R. Tetraplegia after coronary artery bypass, a rare complication. Ann Thorac Cardiovasc Surg 2005;270-2.
Lin CC, Chen SY, Lan C, Ting-Fang Shih T, Lin MC, Lai JS. Spinal cord infarction caused by cardiac tamponade. Am J Phys Med Rehabil 2002;81:68-71 .
Sandson TA, Friedman JH. Spinal cord infarction: report of 8 cases and review of the literature. Medicine 1989;68:282-92.
Blumbergs PC, Byrne E. Hypotensive central infarction of the spinal cord. J Neurol Neurosurg Psychiatry 1980,43:751-53.
Hwang NC, Singh P, Chua YL. Quadriparesis after cardiac surgery. J Cardiothorac Vasc Anesth 2008;22:587-9 .
Kato Y, Nishida N, Taguchi T. Paraplegia caused by posture during MRI in a patient with cervical disk herniation. Orthopedics 2010;33:448-50 .
Geyer TE, Naik MJ, Pillai R. Anterior spinal artery syndrome after elective coronary artery bypass grafting. Ann Thorac Surg 2002;73:1971-3.
Fujioka S, Niimi Y, Hirata K, Nakamura I, Morita S. Tetraplegia after coronary artery bypass grafting. Anesth Analg 2003;97:979-80.
Naja Z, Zeidan A, Maaliki H, Zoubeir S, El-Khatib R, Baraka A. Tetraplegia after coronary artery bypass grafting in a patient with undiagnosed cervical stenosis. Anesth Analg 2005;101:1883-4 .
Harris RE, Reimer KA, Crain BJ, Becsey DD, Oldham HN Jr. Spinal cord infarction following balloon support. Ann Thorac Surg 1986;42:206-7.
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