Spinal cord infarction following endoscopic variceal ligation

A case report of spinal cord infarction following endoscopic variceal ligation.

To describe an exceedingly rare case of spinal cord infarction following endoscopic variceal ligation.

Department of Orthopaedic Surgery, Kagoshima, Japan.

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.

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.

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.