Abstract
We experienced a case of delayed hemiplegia after hemiarch replacement for acute Stanford type A aortic dissection. The patient was a 65-year-old man who presented to his local physician for sudden chest pain. He was diagnosed as acute Stanford type A aortic dissection with false lumen occlusion and brought to our hospital. The patient was in a clear conscious state before surgery and had no motor impairment in extremities. Cardiopulmonary bypass was established between left femoral artery and right atrium, and hemiarch replacement was performed with moderate hypothermic circulatory arrest at a bladder temperature of 27°C and selective cerebral perfusion. The postoperative course was good, and the patient was weaned from the ventilator 8 hours after surgery. Ten hours after surgery, the patient developed incomplete paralysis of the right lower extremity, and a CT scan of the head showed no acute intracranial lesion. Spinal cord ischemia was considered to be the cause of the symptom and we promptly commenced spinal cord drainage, steroid pulse, and naloxone administration. Immediately after the start of the treatment, the patient was enabled to raise his right knee. Rehabilitation was continued, and the patient was discharged from the hospital on the 20th day after the operation with ADL equivalent to that before the surgical procedure.
