paralysis side effect of operation?

[C_Clark]

My brother, 42, went in for surgery to repair a dissected aorta back in January. He was having extreme high blood pressure (over 300) and was flown by helicopter to the Arizona Heart Hospital in Phoenix.

They went in a repaired the dissection up near his heart and after the operation they realized he was not getting blood flow to his legs. They took him back in and noted another dissection near the lower aorta (waist area) and went in to fix that and restore the blood flow.

As a result of lack of blood flow, they had to remove portions of his intestines and gall bladder and his kidneys stopped functioning. They did restore circulation to his legs.

He was in the ICU for about 5 weeks before regaining consciousness and an additional side effect is that he now has no feelings below the waist. He has recently, in the last week, been moved from ICU to a care facility in Phoenix and the doctors have not given any sort of explanation on why he would not be able to move his legs.

We are at a loss on how/why he cannot move his legs... Any suggestions on how to determine this? I am hoping it is some sort of temporary side effect of the surgeries and not some neglect on the side of the physicians.

[Wise Young]

My brother, 42, went in for surgery to repair a dissected aorta back in January. He was having extreme high blood pressure (over 300) and was flown by helicopter to the Arizona Heart Hospital in Phoenix.

They went in a repaired the dissection up near his heart and after the operation they realized he was not getting blood flow to his legs. They took him back in and noted another dissection near the lower aorta (waist area) and went in to fix that and restore the blood flow.

As a result of lack of blood flow, they had to remove portions of his intestines and gall bladder and his kidneys stopped functioning. They did restore circulation to his legs.

He was in the ICU for about 5 weeks before regaining consciousness and an additional side effect is that he now has no feelings below the waist. He has recently, in the last week, been moved from ICU to a care facility in Phoenix and the doctors have not given any sort of explanation on why he would not be able to move his legs.

We are at a loss on how/why he cannot move his legs... Any suggestions on how to determine this? I am hoping it is some sort of temporary side effect of the surgeries and not some neglect on the side of the physicians.

Dear C Clark,

I am so sorry to hear about your brother. A small arterial branch of the aorta provides the blood supply to the mid-thoracic cord. Called the Artery of Adamkiewicz, this artery supplies most of the blood flow to the thoracic spinal cord. During the repair of the aorta, if the aorta is clamped above the T6 spinal vertebral level for longer than 30 minutes, there is usually damage to the spinal cord. In the case of your brother, there is the complication of the second dissection below the original dissection and this seemed to caused sufficient ischemia to damage his gut and other organs. The spinal cord is more sensitive to ischemia than the kidney and guts. The second period of ischemia is likely to have damaged the spinal cord further.

It is often hard to predict the extent of ischemic damage. That is because some blood flow may continue down the spinal cord. The only way to tell is now a careful neurological examination to determine where his sensory level is, which will tell where his injury is in the upper thoracic cord. They should do careful reflex testing of his legs. If your brother has spasticity or increased reflexes in the legs, that is a very good sign because it would indicate that his spinal cord below the thoracic segments still are excitable and have neurons. If there is no spasticity, that suggests that there has been damage but one often cannot tell how much damage just from the loss of reflexes. Neurophysiological testing may be necessary to determine the extent of neuronal loss.

Wise.

[twinkletoes]

thats exactly what i had sept my aorta toar four times and i was misdiagnosed it took so long to figure it out they didn't expect me to survive they said 10% chance. but i did although i am now a t-6 paraplegic but i have no spacticity

[C_Clark]

Thanks for the response and taking the time.

Your explanation was clear and understandable, glad I found this forum. I am unaware if they have done any reflex testing yet as their primary concern all along was just to keep him alive.

[fishin'guy]

Wow, another surgical mishap. Sorry to hear about ur brother. What a life changing event. Life is so delicate, we never know what will happen. I hope they get testing done asap. Keep us posted, and keep coming back as he progresses as there are many here who can give encouraging and informative information. Good luck G_ Clark

[SCI-Nurse]

C Clark, your brother is very young to have an aortic aneurysm. There is significant risk of hypoxia to the cord with traditional surgical repairs of this problem, as high as 20% of people having this surgery will have some weakness or impairment or worse. Of course not having the surgery runs a significant risk of sudden death (like John Ritter). Many people with this cause of injury do get some function back over the first 1-2 years.

Is your brother by any chance a military veteran? If so, he can get rehab and care through the VA at a VA SCI Center. Let us know. We can help.

(KLD)

[C_Clark]

No, he is not a veteran. Yeah, from what I can tell his condition normally doesn't occur until much later in life. Even the doctors and nurses were surprised to see someone as young as him with that condition.

The benefit of that was they are attributing that to his survival, as they were not expecting him to survive.