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- OpenAccess
Transient neurologic deficit with complete recovery due to cervical spinal cord infarction after preoperative embolization for metastatic lesion of malignant pheochromocytoma at proximal thoracic spine
摘要
Spinal cord infarction after preoperative transarterial embolization for metastatic spinal lesions is uncommon and usually leads to complete paralysis. Transient neurologic deficit due to spinal cord infarction after preoperative embolization for spinal metastases has never been reported in the literature. A 30-year-old female patient was diseased with malignant pheochromocytoma and multiple metastases to lung and bones. She suffered from refractory pain at upper back and numbness at her body below xiphoid process but no motor deficit was noted at extremities. Magnetic resonance imaging (MRI) revealed paraspinal and epidural lesions originating from T2 to T4 vertebrae with compression to spinal cord. Preoperative embolization was executed to the spinal metastases with the intent to reduce intraoperative bleeding. Embolization procedure was performed to bilateral costocervical trunk, 3rd and 4th intercostal arteries with 400 μm Embozene® microsphere under local anesthesia. The procedure was discontinued immediately after development of severe hypertension that might be related to the pheochromocytoma and was treated with intravenous antihypertensive drug. There was no neurologic deficit until 6.5 hours after the procedure when weakness at right lower extremity and hypesthesia at left arm developed. Emergent MRI showed focal infarcts in spinal cord at right aspect of C5 and left C4 levels. With adequate hydration but no administration of steroid, muscle power gradually recovered in a few hours. Posterior instrumentation, neural decompression and tumor debulking were performed 2 days after embolization as scheduled. One week after the event of spinal cord infarction, she could stand up and walk without aid. Even though it is rare, spinal cord infarction is an important differential diagnosis for sudden decrease of muscle power after preoperative embolization for spinal metastases. Although complete paralysis is more common, transient neurologic deficit with complete recovery could happen in patients with minor infarcts in the spinal cord.
延伸閱讀
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