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Case reports

Delayed paraplegia associated with vertebral necrosis after type A dissection surgery

Department of Cardiac Surgery, Heart Centre Leipzig, Strümpellstrasse 39, 04289 Leipzig,Germany

Received 22 April 2007; received in revised form 1 October 2007; accepted 15 October 2007.

^_* Corresponding author. Tel.: +49 1632032089; fax: +49 3418651483. (Email: evagird{at}centras.lt).

Paraplegia is a rare complication of surgery for acute type A aortic dissection. We report a case of delayed postoperative paraplegia associated with necrosis of the thoracic vertebral bodies and soft tissue. The pathogenesis of delayed postoperative paraplegia is unknown, but our case report would strongly suggest ischemia of the descending thoracic intercostal arteries as the causative mechanism. The precipitating episode (respiratory distress syndrome with hemodynamic instability) might have promoted the compromised spinal circulation to become clinically evident in our patient. Treatment for this serious complication is mostly supportive, although CSF drainage may be helpful in the acute phase.

Key Words: Type A dissection • Paraplegia • Cerebrospinal fluid drainage