SCI
Bernardo Gonzalez, MD
Resident Physician
Baylor College of Medicine
Houston, Texas, United States
Symonne Martin, MD
Resident Physician
Baylor College of Medicine
Houston, Texas, United States
Sameer Siddiqui, MD
Spinal Cord Injury Staff Physician/Assistant Professor
Michael E. DeBakey VA Medical Center/H. Ben Taub Department of PM&R, Baylor College of Medicine
Manvel, Texas, United States
Donna Huang, M.D.
Assistant Professor
H. Ben Taub Department of PM&R, Baylor College of Medicine
Houston, Texas, United States
Bernardo E. Gonzalez, MD
Baylor College of Medicine
Houston, Texas, United States
T9 AIS C Incomplete paraplegia secondary to cardiogenic shock
Case Description:
A 50-year-old male with a complex medical history most notable for HFrEF s/p orthotopic heart transplant on chronic immunosuppression complicated by prior acute cellular rejection and opportunistic infections, as well as ESRD on hemodialysis and multiple VTE’s, was admitted with acute decompensated heart failure progressing to cardiogenic shock due to acute cellular rejection requiring ECMO and Impella/IABP support. His course was further complicated by leukopenia and pseudomonas bacteremia. On hospital day 17, the patient developed abrupt bilateral lower extremity weakness. MRI revealed T10–T11 T2 hyperintensity consistent with posterior spinal cord infarction, attributed to prolonged hypoperfusion. Upon stabilization, spinal cord injury medicine consultation confirmed T9 AIS C incomplete paraplegia, and he was transferred to Spinal Cord Injury (SCI) unit for inpatient rehabilitation.
Discussions:
Spinal cord ischemia is a rare but devastating complication of systemic hypoperfusion. The majority of cases involve the anterior spinal artery territory due to its limited collateral supply, while posterior spinal infarctions are distinctly rare. This patient’s posterior cord ischemia following cardiogenic shock represents an atypical presentation outside of aortic pathology or surgery.
This case is further distinguished by the patient’s complex medical background, which posed unique challenges for management and rehabilitation planning. Despite these barriers, collaboration with specialists and early initiation of a comprehensive SCI rehabilitation program including bowel and bladder management, neuropathic pain management, skin integrity monitoring, spasticity surveillance, and progressive mobility was essential in preventing secondary complications and optimizing functional outcomes.
Conclusions:
This case highlights the need to recognize spinal cord ischemia as a rare sequela of cardiogenic shock, particularly in medically complex patients. Multidisciplinary collaboration among transplant cardiology, nephrology, and SCI medicine enabled medical stabilization and progression in therapy. Early, comprehensive rehabilitation was essential for managing neurogenic sequelae and optimizing functional outcomes.
