Spinal Cord Paralysis Following Sclerotherapy for Esophageal Varices

Authors

  • Ernest Seidman,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Andrée M. Weber,

    Corresponding author
    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
    • Andrée M. Weber, M.D., Gastroenterology Unit, Hǒpital Saint-Justine, 3175 Cote Sainte-Catherine, Montreal, Quebec, Canada H3T 1C5.
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  • Claude L. Morin,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Roméo Ethier,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Jacques B. Lamarche,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Ara J. Guerguérian,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Guy Geoffroy,

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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  • Claude C. Roy

    1. Gastroenterology and Neurology Divisions, Department of Pediatrics, and Broncho-oesophagology Section, Hopital Sainte-Justine and University of Montreal, and Department of Radiology, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; and Department of Pathology, Centre Hospitaller Universitaire, University of Sherbrooke, Sherbrooke, Canada
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Abstract

A child with cryptogenic cirrhosis underwent a third session of elective sclerotherapy. Endoscopic therapy consisted of intravascular injection of ethanolamine oleate in varices newly developed at the midesophagus level. Irreversible paraplegia was documented within 8 hr postoperatively. Two years later she eventually died from gastrointestinal bleeding. Autopsy findings were compatible with an infarct of the spinal cord secondary to an occlusion of the anterior spinal artery. Various hypotheses which might explain the passage of the sclerosing material from the esophagus to the anterior spinal artery include: arterial occlusion secondary to venous thrombosis and spinal cord necrosis, accidental injection in an intercostal artery or azygous vein through the esophageal wall, the presence of a congenital arteriovenous fistula or the opening of arteriovenous shunt. Paravasal injection of dilute sclerosing agent might protect against this unusual but dramatic complication.

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