Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 4
Disclosures: Michelle N. Leong, MS, DO: Nothing to disclose
Case Description: Patient underwent aortic valve replacement successfully. Post-operatively, patient had an aortic rupture with massive bleeding and cardiac arrest. Patient required multiple transfusions and pressors for hypotension. Post-resuscitation, patient had lower extremity weakness and truncal instability. Computed tomography of head and spine were unremarkable. Magnetic resonance imaging showed hyperintense T2 signal within the cord at T4, suggestive of spinal infarct.
Setting: Acute Inpatient Rehabilitation Unit
Patient: 55-year-old male with aortic stenosis.
Assessment/Results: Examination showed a Brown-Sequard-like presentation. Patient had right lower extremity weakness with left sided loss of pain and temperature below T4. He also had decreased sensation to light touch from T4-T6 on the right. Truncal ataxia had improved and proprioception was preserved. Because of strict sternal precautions, he was unable to weight bear on arms, requiring modifications in therapy including cardiac walker and suspension support. Patient regained strength in right lower extremity, though sensation did not significantly change.
Discussion: There are numerous reports of spinal cord infarction following cardiac procedures. However, typical spinal cord infarct presents as anterior spinal artery (ASA) syndrome due to anatomy. The ASA is often smaller and more supported by radicular arteries in the thoracic region, leaving it vulnerable to insult. Brown-Sequard syndrome (BSS) is rare as it requires hemi-section of the cord, usually from penetrating wounds. BSS makes up approximately 1-4% of traumatic spinal cord injuries (SCI). No clear data are published on prevalence in non-traumatic SCIs. It is atypical in spinal cord infarction since there is no obvious vascular distribution to cause hemi-section. Rehabilitation in this case focused on lower extremities for transfers and ambulation due to sternal precaution. These modifications in addition to the more favorable prognosis of ambulation in BSS benefited our patient’s recovery.
Conclusion: We present a case of a rare and atypical presentation of spinal cord infarction.
Level of Evidence: Level V
To cite this abstract in AMA style:Leong MN, Huang V. Brown Sequard-like Presentation of Spinal Cord Infarct Post Aortic Valve Replacement: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/brown-sequard-like-presentation-of-spinal-cord-infarct-post-aortic-valve-replacement-a-case-report/. Accessed September 22, 2023.
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