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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
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AFRICA
of the cord lesion, symptoms may vary from mild to moderate
and even from reversible leg weakness to quadriplegia. Fever is a
warning to consider infectious origins such as acute meningitis.
8-13
Involvement of intrinsic cord vessels has been reported with
arteritis such as systemic lupus erythematosus. Anterior spinal
artery occlusion has been reported with arteritis, including that
associated with syphilis and diabetes mellitus; after trauma;
and as a complication of spinal angiography, spinal adhesive
arachnoiditis, administration of intrathecal phenol, and spinal
anaesthesia.
Aortic diseases are blamed for producing spinal infarction
in a variety of situations including dissecting aneurysm; aortic
surgery, especially with aortic cross-clamping above the renal
artery; aortography; atherosclerotic embolisation; and aortic
thrombosis. Uncommon causes include complications of
abdominal surgery, particularly sympathectomy; circulatory
failure as a result of cardiac arrest or prolonged hypotension; and
vascular steal in the presence of an arteriovenous malformation,
or vascular compression by tumours in the spinal canal, vertebral
fracture, or a herniated intervertebral disk.
12,13
Suspecting neuropathies, we ordered electromyography and
nerve conduction velocity tests, which found peripheral sensory–
motor polyneuropathy, mainly of the demyelinating type, with
a differential diagnosis of acute inflammatory demyelinating
polyneuropathy and critical illness polyneuropathy. A cervical–
thoracic MRI showed the pathological osteophytes and circular
degeneration of the annulus fibrosis of the fifth and sixth
cervical vertebra with a compression in the spinal cord and
consequent ischaemia and oedema of the medulla.
Conclusion
The complication in our case is a rare condition that has not been
discussed in the literature. We considered that this complication
was due to a degenerative vertebral condition with compression
in the spinal cord, exacerbated by placing a prop under the
shoulder to position the body for the sternotomy. Placing a
prop to position the body for CABG surgery is unavoidable and
one cannot consider possible vertebral pathology in all patients
before surgery, especially when the patient does not have any
associated symptoms. Therefore in this patient, the diagnosis of
paraparesis was made accidentally.
References
1.
Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N,
Wolman R,
et al
. Adverse cerebral Outcomes after coronary bypass
Surgery. Multicenter Study of Perioperative ischemia Research Group
and the ischemia Research and Education Foundation investigators.
N
Engl J Med
1996;
525
: 1857.
2.
Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch
JF,
et al
. Stroke after cardíac surgery: A risk factor analysis Of 16,184
consecutíve adult patients.
Ann Thorac Surg
2003;
75
: 472
3.
Hogue CW Jr, Barzilai B, Pieper KS, Coombs LP, DeLong ER,
Kouchoukos NT,
et al
. Sex differences in neurologícal outcomes and
mortality after cardiac surgery: a Society of Thoracic Surgery National
Database report.
Circulation
2001;
103
: 2133–2137.
4.
Nussmeier NA. A review of risk factors for adverse neurologic Outcome
after cardiac Surgery
. J Extracorp Technol
2002;
34
: 4.
5.
Ridderstolpe L, Ahlgren E, Gill H, Rutberg H. Risk factor analysis
Of early and delayed cerebral complications after cardiac surgery.
Cardiothorac Vasc Anesth
2002;
16
: 278–285.
6.
Wolman RL, Nussmeier NA, Aggarwal A, Kanchuger MS, RoachGW,
Newman MF,
et al
. Cerebral injury after cardiac surgery: identification
of a group at extraordinary risk. Multicenter Study of Perioperative
lschemia Research Group (MCSPI) and the lschemia Research
Education Foundation (lREF) lnvestigators.
Stroke
1999;
30
: 514–522.
7.
Ahonen J, Salmenpera M. Brain injury after adult cardiac Surgery.
Acta
Anaesthesiol Scand
2004;
48
: 4–19.
8.
Hughes RA, Swan AV, Raphael JC, Annane D, van Koningsveld R, van
Doorn PA. Immunotherapy for Guillain-Barre syndrome: a systematic
review.
Brain
2007;
130
: 2245–2245.
9.
Chawla J, Gruener G. Management of critical illness polyneuropathy
and myopathy.
Neural Clin
2010;
28
: 961, 77
10. Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarc-
tion: etiology and outcome.
Neurology
1996;
47
: 32130.
11. Weber P, Vogel T, Bitterling H, Utzschneider S, von Schulze Pellengahr
C, Birkenmaier C. Spinal cord infarction after operative stabilisation
of the thoracic spine in a patient with tuberculous spondylodiscitis and
sickle cell trait.
Spine
2009;
34
: E294–297.
12. Hogan EL, Romanul FC. Spinal cord infarction occurring during inser-
tion of aortic graft.
Neurology
1966;
16
: 67–74. 13. Ross RT. Spinal cord
infarction in disease and surgery of the aorta.
Can J Neurol Sci
1985;
12
: 289–295.
13. Ross RT. Spinal cord infarction in disease and surgery of the aorta.
Can
J Neurol Sci
1985;
12
: 289–295.