Case report: Medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting

Frontiers in Neurology, 2023 · DOI: 10.3389/fneur.2023.1097252 · Published: May 5, 2023

Simple Explanation

The paper discusses a rare complication called white cord syndrome (WCS), which typically occurs after spinal decompression surgery and involves neurological deterioration due to spinal cord reperfusion injury. This case presents a unique instance of WCS. This specific case is unique because it involves both the medulla oblongata (part of the brainstem) and the cervical cord (part of the spinal cord) being affected by reperfusion injury. This occurred after the patient underwent a procedure to open a blocked vertebral artery in the brain. The patient's symptoms improved after treatment, and a 1-year follow-up showed positive results. This case highlights the importance of recognizing and treating this rare complication early, and of maintaining blood flow during similar procedures to prevent such injuries.

Study Duration

1-year follow-up

Participants

A 56-year-old male

Evidence Level

Case Report

Key Findings

1
Concomitant reperfusion injury in the medulla oblongata and cervical cord is extremely rare after vertebral artery angioplasty and stenting.
2
Intraoperative flow arrest in the vertebral artery during endovascular treatment can lead to reperfusion injury in the medulla oblongata and cervical cord.
3
Maintaining antegrade flow during vertebral artery endovascular treatment is crucial to prevent intraoperative infarction and postoperative reperfusion injury.

Research Summary

This case report describes a 56-year-old male who developed a rare complication involving reperfusion injury in both the medulla oblongata and cervical cord following vertebral artery angioplasty and stenting. The patient initially presented with an ischemic stroke and underwent endovascular treatment for vertebral artery stenosis. Post-operatively, he experienced neurological deterioration, which was identified as reperfusion injury. The patient's condition improved with treatment, and a 1-year follow-up showed a favorable outcome. The authors emphasize the importance of recognizing this rare complication and maintaining adequate blood flow during similar procedures.

Practical Implications

Clinical Awareness

Clinicians should be aware of the possibility of concomitant medulla oblongata and cervical cord reperfusion injury following vertebral artery angioplasty and stenting.

Procedural Precautions

Maintaining antegrade flow during vertebral artery endovascular treatment is crucial to minimize the risk of reperfusion injury.

Informed Consent

The risk of this rare complication should be included in informed consent discussions with patients undergoing vertebral artery angioplasty and stenting.

Study Limitations

1
Single case report limits generalizability.
2
Lack of diffusion-weighted imaging of the cervical spine.
3
Underlying mechanism requires further investigation due to the lack of surgical decompression.

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