Successful Management of Acute Type A Aortic Dissection with Spinal Cord Ischemia: A 3-Case Series
- VernacularTitle:脊髄虚血を合併したStanford A型急性大動脈解離に対する治療経験
- Author:
Tomoki TAMURA
1
;
Yurie OTOMO
1
;
Tetsuya HORAI
1
Author Information
- Keywords: spinal cord ischemia; acute type A aortic dissection; cerebrospinal drainage; naloxone
- From:Japanese Journal of Cardiovascular Surgery 2023;52(2):103-108
- CountryJapan
- Language:Japanese
- Abstract: Spinal cord ischemia (SCI), a complication of acute aortic dissection, has no established treatment. Here, we report the successful management of three cases of acute type A aortic dissection (ATAAD) with SCI using a multidisciplinary approach. Case 1: A 55-year-old man presented with paraparesis due to ATAAD (non-communicating type), cardiac tamponade, and no loss of consciousness. He underwent emergency surgery for ascending aortic replacement. He awoke 3 h after the surgery; however, as his paralysis was not improved, we initiated multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy. These treatments led to the complete resolution of his symptom; he was discharged on Day 32, with no neurological deficits. Case 2: A 50-year-old woman presented with complete paralysis of the left lower limb due to ATAAD (communicating type) but no loss of consciousness. She underwent emergency surgery for ascending aortic replacement. She awoke 2 h after the surgery; however, as her paralysis was not improved, multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy were initiated, which led to partial resolution of the symptoms. She could walk with orthotics and was discharged on Day 57. Case 3: A 43-year-old man presented with paraparesis of the left lower limb due to ATAAD (non-communicating type). He was hemodynamically stable, with no loss of consciousness. The ATAAD was conservatively managed, and multidisciplinary treatment with cerebrospinal drainage, continuous infusion of naloxone, and steroid pulse therapy was administered. These therapies led to the complete resolution of his symptoms; he was discharged on Day 46, with no neurological deficits. Hence, for ATAAD with SCI, multidisciplinary treatment, including emergency surgery, is an important therapeutic strategy.
