Case Report
Spinal Cord (2008) 46, 241–242; doi:10.1038/sj.sc.3102092; published online 19 June 2007
Spinal cord infarction following endoscopic variceal ligation
K Tofuku1, H Koga1, T Yamamoto1, K Yone1 and S Komiya1
1Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Sciences, Kagoshima, Japan
Correspondence: Dr K Tofuku, Department of Orthopaedic Surgery, Kagoshima Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan. E-mail: tofuku@m2.kufm.kagoshima-u.ac.jp
Received 5 April 2007; Revised 15 May 2007; Accepted 19 May 2007; Published online 19 June 2007.
Abstract
Study design:
A case report of spinal cord infarction following endoscopic variceal ligation.
Objectives:
To describe an exceedingly rare case of spinal cord infarction following endoscopic variceal ligation.
Setting:
Department of Orthopaedic Surgery, Kagoshima, Japan.
Methods:
A 75-year-old woman with cirrhosis caused by hepatitis C virus, who was admitted to our hospital for the treatment of esophageal varices, experienced numbness of the hands and lower extremities bilaterally following an endoscopic variceal ligation procedure. Sensory and motor dysfunction below C6 level progressed rapidly, resulting in inability to move the lower extremities the following day. Magnetic resonance imaging of the spine revealed abnormal spinal cord signal on T2-weighted images from approximately C6 through T5 levels, which was diagnosed as spinal cord infarction.
Results:
The patient underwent hyperbaric oxygen treatment. Her symptoms and signs related to spinal cord infarction gradually remitted, and nearly complete disappearance of neurological deficits was noted within 3 months after the start of treatment.
Conclusion:
We speculate that the pathogenesis of the present case may have involved congestion of the abdominal–epidural–spinal cord venous network owing to ligation of esophageal varices and increased thoracoabdominal cavity pressure.
Keywords:
endoscopic variceal ligation, hyperbaric oxygen, spinal cord infarction
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