Recognition of Significantly Delayed Spinal Cord Ischemia Following Thoracic Endovascular Aortic Repair: A Case Report and Review of the Literature

Figures

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  Figure 1. Aortic endoleak and subsequent endoleak progression and thrombosis (A) Computed tomography angiogram (CTA) of the chest/abdomen/pelvis demonstrating an endoleak with filling throughout the false lumen (red arrows) from a prior admission. (B) CTA chest/abdomen/pelvis from the patient’s presented admission showing further propagation of the endoleak compared to in A (red arrows). There is an absence of contrast within the dilated false lumen (blue arrows), suggesting interval thrombosis of a large portion of the endoleak from about T5-T8.

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  Figure 2. Thoracic spinal cord MRI Sagittal (A) and axial (B) T2-sequences of a thoracic spinal cord magnetic resonance imaging (MRI) without contrast demonstrating a disc herniation at the T7-8 interspace abutting the spinal cord eccentrically on the left (red arrow). There is space within the thecal sac seen dorsally (blue arrows).

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  Figure 3. MRI of the thoracic spine in flexion T2-sequences of a MRI thoracic spine without contrast in a neutral (left) and with the patient in flexion (center) showing no dynamic compression on the spinal cord from the T7-8 disc herniation. Short T1 inversion recovery (STIR) sequences from this MRI (right) additionally show no edema within the intervertebral disc to suggest an acute herniation (red arrow).

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  Figure 4. T2 sequences of an MRI thoracic spine Sagittal (center) and axial cuts through the mid-vertebral body at various levels (labeled) on post-injury day four demonstrating T2 signal change throughout the spinal cord, suggestive of an ischemic event.

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  Figure 5. Flowsheet A flowsheet demonstrating the relationship between spinal cord perfusion pressure (SCPP), mean arterial pressure (MAP), and intrathecal pressure (ITP). The interventions employed for this patient are shown, including the proposed mechanisms of each therapy.