Title: A case of T10 infarction after thoracic abdominal aortic dissection repair with mixed upper and motor neuron presentation
Karen Lou Luna, MD
RESIDENT
Eastern Virginia Medical School
ORLANDO, Florida, United States
Eason Barclay, MS
Medical Student
Eastern Virginia Medical School
Norfolk, Virginia, United States
Nataly Montes-Chinea, MD
Assistant Professor
Eastern Virginia Medical School
Norfolk, Virginia, United States
Case diagnosis: Ventral Horn Syndrome
Case Description:
A 52-year-old male with a history of type A and B aortic dissections underwent elective graft repair for an enlarging thoracoabdominal aneurysm. Post-operatively, the patient developed acute onset right lower extremity sensory and motor deficits, generalized hyperreflexia, upper motor neuron signs (Hoffman's signs, Babinski reflex), and bladder incontinence. Magnetic resonance imaging revealed a T7 spinal cord infarct with additional ventral cord long segment signal abnormality. Electromyography/nerve conduction study demonstrated severe polyradiculomyelopathy of the right lower extremity with subacute left S1 radiculopathy. The observed electromyography changes are consistent with possible ischemia affecting the ventral horn, as reported in the MRI findings. Further imaging showed additional right C6-C7 moderate to severe foraminal narrowing. Per the American Spinal Injury Association (ASIA) impairment scale, the patient's neurologic level of injury was C7 ASIA D with confounding factors.
Discussions:
This case presents a rare combination of upper and lower motor neuron symptoms in anterior cord syndrome, contributing to the limited literature on such presentations. The coexistence of UMN and LMN lesions significantly impacts motor function, complicates diagnosis, and affects prognosis, underscoring the complexity of this condition. The patient's atypical symptoms highlight the complexity of neurological disorders following thoracoabdominal aortic surgery. The case suggests that the presence of a CSF drain could have potentially mitigated more severe complications, emphasizing the importance of implementing such protective strategies in high-risk procedures. Further research is needed to better understand the mechanisms behind mixed upper and lower motor neuron presentations in spinal cord infarction and to develop more effective preventive and treatment strategies.
Conclusions:
Patients atypical symptoms in this case highlight the complexity of postoperative spinal complications. The limited existing data on such cases underscores the importance of documenting and studying these rare presentations.
