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1Research Service, VA Boston Healthcare System, and Harvard Medical School, Boston, MA, USA. jfrisbie@comcast.com
Spinal Cord
|May 19, 2010
Summary
Pulmonary embolism (PE) can recur in patients with chronic paraplegia, especially after surgery and during periods of immobility or infection. This case highlights the critical risk of recurrent PE in spinal cord injury patients.
Area of Science:
- Cardiology
- Pulmonology
- Neurology
Background:
- Pulmonary embolism (PE) is a potentially fatal condition that may be highly prevalent in individuals with chronic spinal cord lesions.
- Spinal cord injuries can predispose individuals to venous thromboembolism due to immobility and altered physiological states.
Observation:
- A 60-year-old male with T10 motor complete paraplegia experienced a massive PE 41 days post-laminectomy for arteriovenous malformation correction.
- Five years later, following vertebral osteomyelitis, antibiotics, and bed rest, the patient suffered a fatal recurrent PE during mobilization.
Findings:
- The initial PE was diagnosed via lung scan and suggested by electrocardiogram (ECG) findings of right bundle branch block (RBBB), resolving with anticoagulation.
- The autopsy confirmed a massive pulmonary artery thromboembolus, indicating recurrence associated with infection and mobilization after bed rest.
Implications:
- This case underscores the significant risk of recurrent PE in patients with chronic paraplegia, particularly when compounded by infection and changes in mobility.
- Clinicians should maintain a high index of suspicion for PE in spinal cord injury patients presenting with cardiopulmonary symptoms, especially after surgical interventions or during periods of immobility and infection.
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