Abstract
Purpose
The onset of anterior cervical myelopathy in the early postoperative period is an unusual complication after cardiac surgery without extracorporeal circulation in which haemodynamic stability was maintained. We report a patient who developed anterior cervical myelopathy after cardiac surgery.
Clinical features
A 53-yr-old man with no serious associated medical problems underwent cardiac surgery without extracorporeal circulation to repair a ruptured left ventricle. Haemodynamic stability was maintained throughout the procedure but the patient developed flaccid paraparesis and dissociated sensory loss, three hours later Early recognition of the clinical picture and prompt initiation of steroid treatment facilitated a successful outcome. The definitive diagnosis was based on magnetic resonance findings days after surgery.
Conclusion
The onset or aggravation of neurological symptoms in the postoperative period may be avoided by thorough search for medullary pathology in the patient’s background and by using particular care when performing manoeuvres dunng the penoperative period, not only to ensure haemodynamic stability, thus preserving medullary perfusion, but also to avoid mechanical compression of a spinal segment.
Résumé
Objectif
L’apparition à la période postopératoire d’une myélopathie cervicale antérieure constitue une complication inusitée pour une intervention cardiaque sans circulation extracorporelle (CEC) et sans altération de la stabilité hémodynamique. Nous rapportons le cas d’un patient victime d’une myélopathie cervicale après une ch churgie cardiaque.
Éléments cliniques
Un homme de 53 sans problèmes médicaux associés importants a subi une chirurgie sans CEC pour la réparation d’une rupture ventriculaire gauche. La stabilité hémodynamique a été maintenue pendant l’intervention mais le patient a développé une paraparésie flasque et une perte de sensibilité dissociée trois heures après l’intervention. La reconnaissance précoce du tableau clinique et l’initiation rapide de la corticothérapie a permis une évolution favorable.
Conclusion
À la période postopératoire, l’apparition et l’aggravation de symptômes neurologiques peuvent être évitées par la recherche méticuleuse d’une pathologie médullaire préalable. Pendant la période périopératoire. il faut assurer la stabilité hémodynamique et éviter la compression mécanique du rachis.
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Muñoz, C.L., del García, V.S., Gonzalez, A. et al. Anterior cervical myelopathy in the early postoperative period. Can J Anaesth 44, 872–876 (1997). https://doi.org/10.1007/BF03013164
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DOI: https://doi.org/10.1007/BF03013164