2023 Volume 28 Issue 1 Pages 34-39
We report a case of infarction extending from medulla oblongata to cervical cord that developed after coil embolization of a ruptured basilar artery aneurysm. A 54‒year‒old comatose woman was brought to us, and was diagnosed as WFNS Grade V subarachnoid hemorrhage caused by a ruptured basilar‒left superior cerebellar artery aneurysm. She underwent coil embolization next day after onset. The procedure ended without incident, and patency of anterior spinal artery (ASA) had been confirmed throughout the procedure. It was found that, however, she had been tetraplegic and her spontaneous respiration drive had disappeared. Cervical spine MRI 14 days after onset showed infarction extending from the medulla to the cervical cord. After rigorous rehabilitation, she achieved neurological recovery and was referred to a rehabilitation hospital 123 days after onset. After reviewing an intraoperative video, it was thought that wedge of a guiding catheter into the vertebral artery might have been the cause. Literature review found several similar cases. We learned that wedge of a guiding catheter be avoided as much as possible, and when it happens, proactive therapeutic measures to prevent ASA hypoperfusion be taken.
