skip to main content

Spinal Cord Ischaemia Post-Aortic Surgery — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

HardCardiothoracic AnaesthesiaSpinal Cord Ischaemia Post-Aortic SurgeryFRCA Final

A 65-year-old woman is admitted to the ICU after emergency open repair of a leaking thoracoabdominal aortic aneurysm involving prolonged aortic cross-clamping and perioperative hypotension. On awakening, she has bilateral flaccid paraplegia, absent lower-limb reflexes and urinary retention. Below T10, pinprick and temperature sensation are absent, but vibration and joint-position sense are preserved. Which diagnosis best explains this neurological pattern?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Anterior spinal artery syndrome

The answer is A, anterior spinal artery syndrome. Thoracoabdominal aortic repair can reduce spinal cord perfusion through interruption of segmental arteries, compromise of the artery of Adamkiewicz and systemic hypotension. Ischaemia of the anterior two-thirds of the cord damages the corticospinal tracts, spinothalamic tracts and anterior horns, causing paraplegia and loss of pain and temperature. Acute infarction may initially produce flaccidity and areflexia because of spinal shock. The dorsal columns are supplied predominantly by the posterior spinal arteries, so vibration and joint-position sense are preserved. A spinal epidural haematoma or vertebral compression would usually cause a less selectively dissociated sensory deficit. Posterior spinal artery syndrome predominantly impairs vibration and proprioception. A bilateral plexus injury would not produce a thoracic sensory level or this selective tract pattern.

Reference: Janjua S, et al. Anterior Spinal Artery Syndrome After Bronchial Embolization for Hemoptysis: A Case Report and Literature Review. BMJ Neurology Open. 2024;6:e000684. https://pubmed.ncbi.nlm.nih.gov/37817848/