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Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: A case report and plea for a national.

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Presentation on theme: "Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: A case report and plea for a national."— Presentation transcript:

1 Reversal of twice-delayed neurologic deficits with cerebrospinal fluid drainage after thoracoabdominal aneurysm repair: A case report and plea for a national database collection  Ali Azizzadeh, MD, Tam T.T. Huynh, MD, Charles C. Miller, PhD, Hazim J. Safi, MD  Journal of Vascular Surgery  Volume 31, Issue 3, Pages (March 2000) DOI: /mva Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 A , Correlation between CSF pressure and neurologic function. The patient had delayed onset paraplegia (Tarlov score 0) at 6 hours after the operation, with a CSF pressure of 17 mm Hg. With prompt CSF drainage, CSF pressure was lowered to below 10 mm Hg and the patient regained leg movements (Tarlov score 4) within the next hour. At 34 hours after the operation, the patient again became paraplegic (Tarlov score 4), with CSF pressure elevated to 12 mm Hg. Although the CSF pressure elevation was due to lumbar catheter occlusion, this was not recognized for 6 hours. A new lumbar drain was then inserted, and CSF drainage was reinstituted, with resolution of the neurologic deficits over the next 12 hours. Time-point zero denotes the time the patient was admitted to the intensive care unit. The different Tarlov scores are defined in Appendix I. B , Postoperative fluctuations in systolic arterial pressure (SBP ) and mean arterial pressures (MAP ). There were no significant changes in mean or systolic arterial pressures during the periods of neurologic deficits. Values shown are the mean ± SD. Time-point zero denotes the time the patient was admitted into the intensive care unit. *Duration of the first delayed paraplegia event; **duration of the second delayed paraplegia event. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 2 Sagittal T2-weighted magnetic resonance images of the upper (A) and lower (B) spinal cord obtained on postoperative day 15 showed no evidence of infarction. Arrows denote the outline of the spinal cord. Journal of Vascular Surgery  , DOI: ( /mva ) Copyright © 2000 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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