Abstract
Objective: We report three cases of patients with acute spinal cord infarction (SCI) with improvement in weakness after lumbar drain placement.
Background: Numerous studies have shown CSF drainage via lumbar drain is effective in preventing SCI for patients undergoing thoracoabdominal aortic aneurysm surgery. When combined with augmentation of systemic blood pressure, CSF drainage reduces risk of spinal cord infarction by minimizing the resistance to afferent spinal cord blood supply and increasing perfusion pressure. By the same mechanism, patients with acute spinal cord infarction (SCI) may benefit from lumbar drain placement, though this has not been previously studied.
Design/Methods: A retrospective review from 2013–2016 of three patients diagnosed with acute SCI who underwent lumbar drain placement.
Case one: 77 year old male with atrial fibrillation underwent endovascular thoracic aortic aneurysm repair. His lumbar drain was discontinued two days later. Seven days post operatively he developed complete paraplegia. MRI lumbar spine showed T2 hyperintensity at T12-L1 concerning for SCI. Lumbar drain was replaced with improvement in examination and ambulatory status at discharge.
Case two: 61 year old male with hypertension presented with acute bilateral lower extremity weakness. CTA showed a type B distribution intramural hematoma from the origin of the subclavian artery into the abdomen. MRI was unremarkable but given strong clinical suspicion for SCI, lumbar drain was placed with significant improvement in weakness.
Case three: 61 year old male who underwent pulmonary artery embolization and developed acute unilateral lower extremity weakness and sensory deficit following the procedure. MRI showed diffusion restriction at T2/T3. Lumbar drain was placed and the patient improved over several days with discharge to acute rehabilitation.
Conclusions: CSF drainage with blood pressure augmentation may be beneficial in patients with acute SCI of varying etiologies. More studies are needed to determine the utility of this finding.
Disclosure: Dr. Strohm has nothing to disclose. Dr. John has nothing to disclose. Dr. Hussain has nothing to disclose.
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