1113 - From Clots to Cords: A Rare Neurologic Sequela of ECMO and Vascular Repair

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

RD

Rishbha Dua, MD

PGY 3 Resident Physician
Larkin Community Hospital- PSC
Miami, Florida, United States
IL

Isabel Lam, DO, MS

Resident Physician
Larkin Community Hospital
Miami Lakes, Florida, United States

Co-Author(s)

RR

Ricardo Rodriguez, MD

Resident Physician
Larkin Community Hospital- PSC
Hialeah, Florida, United States

Submitter(s)

RD

Rishbha Dua, MD

Larkin Community Hospital- PSC
Miami, Florida, United States

Case Diagnosis: Arachnoiditis is a rare inflammatory disorder of the spinal nerve roots that may occur after infection, surgery, or vascular interventions. It is associated with severe neuropathic pain, motor deficits, and long-term disability.

Case Description: A 46-year-old male with no prior medical history presented with syncope, abdominal pain, emesis, and chest pain. Workup revealed extensive bilateral pulmonary emboli with right heart strain and bilateral lower extremity deep vein thromboses. He developed acute hypoxic respiratory failure and cardiogenic shock, requiring systemic alteplase, mechanical thrombectomy, and VA-ECMO support.

After recovery of consciousness, he reported profound bilateral lower extremity weakness (L >R), burning dysesthesias, and numbness. Examination revealed paraparesis, worse in the left leg, with bilateral hypoesthesia. Lumbar MRI showed smooth thickening and enhancement of distal cauda equina nerve roots, suggestive of inflammatory arachnoiditis; thoracic MRI was unremarkable. He completed a one-month course of oral corticosteroids with partial recovery of proximal strength and sensation to the thighs and knees but with persistent distal deficits and bilateral foot drop.

Discussions:

This case highlights arachnoiditis as a rare but severe complication following ECMO and complex vascular procedures. The overlapping features with cauda equina syndrome and lumbosacral plexopathy emphasized the need for systematic diagnosis. Based on MRI findings, arachnoiditis was considered the leading diagnosis, though EMG and nerve conduction studies were recommended to assess for potential compounding etiologies. The patient was managed with intensive rehabilitation and multimodal pain control, yet recovery remained incomplete, with persistent foot drop and hypoesthesia. From a rehabilitation standpoint, this case highlights the long-term disability associated with arachnoiditis and the need for coordinated interdisciplinary care.

Conclusions: Arachnoiditis should be considered in patients developing new neurologic deficits after ECMO and cardiothoracic interventions. Early recognition, systematic exclusion of mimicking conditions, and electrodiagnostic evaluation are essential. Rehabilitation physicians play a central role in pain management, functional restoration, and long-term care.