PDF(Pubmed)
Abstract：
BACKGROUND: Bilateral diaphragmatic dysfunction can lead to dyspnea and recurrent respiratory failure. In rare cases, it may result from high cervical spinal cord ischemia (SCI) due to anterior spinal artery syndrome (ASAS). We present a case of a patient experiencing persistent isolated diaphragmatic paralysis after SCI at level C3/C4 following thoracic endovascular aortic repair (TEVAR) for Kommerell\'s diverticulum. This is, to our knowledge, the first documented instance of a patient fully recovering from tetraplegia due to SCI while still exhibiting ongoing bilateral diaphragmatic paralysis.
METHODS: The patient, a 67-year-old male, presented to the Vascular Surgery Department for surgical treatment of symptomatic Kommerell\'s diverticulum in an aberrant right subclavian artery. After successful surgery in two stages, the patient presented with respiratory insufficiency and flaccid tetraparesis consistent with anterior spinal artery syndrome with maintained sensibility of all extremities. A computerized tomography scan (CT) revealed a high-grade origin stenosis of the left vertebral artery, which was treated by angioplasty and balloon-expandable stenting. Consecutively, the tetraparesis immediately resolved, but weaning remained unsuccessful requiring tracheostomy. Abdominal ultrasound revealed a residual bilateral diaphragmatic paralysis. A repeated magnetic resonance imaging (MRI) 14 days after vertebral artery angioplasty confirmed SCI at level C3/C4. The patient was transferred to a pulmonary clinic with weaning center for further recovery.
CONCLUSIONS: This novel case highlights the need to consider diaphragmatic paralysis due to SCI as a cause of respiratory failure in patients following aortic surgery. Diaphragmatic paralysis may remain as an isolated residual in these patients.
METHODS: The patient, a 67-year-old male, presented to the Vascular Surgery Department for surgical treatment of symptomatic Kommerell\'s diverticulum in an aberrant right subclavian artery. After successful surgery in two stages, the patient presented with respiratory insufficiency and flaccid tetraparesis consistent with anterior spinal artery syndrome with maintained sensibility of all extremities. A computerized tomography scan (CT) revealed a high-grade origin stenosis of the left vertebral artery, which was treated by angioplasty and balloon-expandable stenting. Consecutively, the tetraparesis immediately resolved, but weaning remained unsuccessful requiring tracheostomy. Abdominal ultrasound revealed a residual bilateral diaphragmatic paralysis. A repeated magnetic resonance imaging (MRI) 14 days after vertebral artery angioplasty confirmed SCI at level C3/C4. The patient was transferred to a pulmonary clinic with weaning center for further recovery.
CONCLUSIONS: This novel case highlights the need to consider diaphragmatic paralysis due to SCI as a cause of respiratory failure in patients following aortic surgery. Diaphragmatic paralysis may remain as an isolated residual in these patients.
摘要：
背景：双侧膈肌功能障碍可导致呼吸困难和反复发作的呼吸衰竭。在极少数情况下,它可能是由于脊髓前动脉综合征（ASAS）引起的颈脊髓缺血（SCI）。我们介绍了一例患者，在胸血管内主动脉修复术（TEVAR）治疗Kommerel憩室后，SCI后处于C3/C4水平的持续孤立性膈麻痹。这是,根据我们的知识，首次有记录的一例患者从SCI引起的四肢瘫痪中完全恢复，但仍表现出持续的双侧膈肌麻痹。
方法：患者，一位67岁的男性,转诊至血管外科部门，对异常右锁骨下动脉有症状的Kommerell憩室进行手术治疗。经过两个阶段的成功手术，患者出现呼吸功能不全和弛缓性四轻瘫，与脊髓前动脉综合征一致，所有四肢均保持敏感性。计算机断层扫描（CT）显示左椎动脉高度狭窄，通过血管成形术和球囊扩张支架置入治疗。连续,四肢轻瘫立即解决，但断奶仍不成功，需要气管造口术。腹部超声显示残留的双侧膈麻痹。椎动脉血管成形术后14天的重复磁共振成像（MRI）证实SCI处于C3/C4水平。该患者被转移到具有断奶中心的肺部诊所以进一步恢复。
结论：这个新病例强调需要考虑脊髓损伤导致的膈肌麻痹是主动脉手术后患者呼吸衰竭的原因。在这些患者中，膈肌麻痹可能仍然是孤立的残留物。
方法：患者，一位67岁的男性,转诊至血管外科部门，对异常右锁骨下动脉有症状的Kommerell憩室进行手术治疗。经过两个阶段的成功手术，患者出现呼吸功能不全和弛缓性四轻瘫，与脊髓前动脉综合征一致，所有四肢均保持敏感性。计算机断层扫描（CT）显示左椎动脉高度狭窄，通过血管成形术和球囊扩张支架置入治疗。连续,四肢轻瘫立即解决，但断奶仍不成功，需要气管造口术。腹部超声显示残留的双侧膈麻痹。椎动脉血管成形术后14天的重复磁共振成像（MRI）证实SCI处于C3/C4水平。该患者被转移到具有断奶中心的肺部诊所以进一步恢复。
结论：这个新病例强调需要考虑脊髓损伤导致的膈肌麻痹是主动脉手术后患者呼吸衰竭的原因。在这些患者中，膈肌麻痹可能仍然是孤立的残留物。
