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Acute spinal cord ischemia after transarterial chemoembolization of hepatocarcinoma
Isquemia medular aguda tras realización de quimioembolización transarterial de hepatocarcinoma
Antonio José Ruiz Rodrígueza,
, Ana María Bravo Arandab, Carlos Martínez Martínezc, María Eloísa Sáez de Tejada Cervillaa, Álvaro Cabrera Peñad
Corresponding author
a Servicio de Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain
b Servicio de Aparato Digestivo, Hospital Regional Universitario Carlos Haya, Hospital Regional Universitario de Málaga, Spain
c Servicio de Radiodiagnóstico, Hospital Universitario San Cecilio, Granada, Spain
d Servicio de Radiología Intervencionista, Hospital Universitario San Cecilio, Granada, Spain
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Beta-blockers have no clear effects in early cirrhosis without ascites or in end-stage cirrhosis, aspects that mark the upper and lower limits of the therapeutic window. The onset of hyperdynamic circulation, with the development of sodium and water retention and ascites formation, reflects an adaptive response to peripheral vasodilatation and effective hypovolemia. However, as cirrhosis progresses, the cardiovascular response eventually loses its compensatory capacity. At this stage, previous evidence suggested that the hemodynamic effects of beta-blockers in reducing blood pressure and cardiac output may actually result in decreased survival in these patients. 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"" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570521002028?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422001614?idApp=UINPBA00004N" "url" => "/24443824/0000004500000009/v2_202301300757/S2444382422001614/v2_202301300757/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image of the month</span>" "titulo" => "Acute spinal cord ischemia after transarterial chemoembolization of hepatocarcinoma" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "713" "paginaFinal" => "714" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Antonio José Ruiz Rodríguez, Ana María Bravo Aranda, Carlos Martínez Martínez, María Eloísa Sáez de Tejada Cervilla, Álvaro Cabrera Peña" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Antonio José" "apellidos" => "Ruiz Rodríguez" "email" => array:1 [ 0 => "antjosruirod@outlook.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana María" "apellidos" => "Bravo Aranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Carlos" "apellidos" => "Martínez Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "María Eloísa" "apellidos" => "Sáez de Tejada Cervilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Álvaro" "apellidos" => "Cabrera Peña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Regional Universitario Carlos Haya, Hospital Regional Universitario de Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiodiagnóstico, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Radiología Intervencionista, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Isquemia medular aguda tras realización de quimioembolización transarterial de hepatocarcinoma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3319 "Ancho" => 1305 "Tamanyo" => 126051 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI. Sagittal plane of diffusion-weighted image showing diffusion restriction in the distal portion of the cord and conus medullaris (white arrow), possibly related to acute ischaemic injury.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 63-year-old man with liver cirrhosis of mixed aetiology (alcoholic and hepatitis C virus infection) and a diagnosis of a 14-mm hepatocarcinoma in segment III and 40 mm in segment VI. Transarterial chemoembolisation (TACE) of hepatocellular carcinoma was performed by super-selective catheterisation of the feeding arteries of the tumour nodules and they were embolised with doxorubicin (DC-Beads 100−300 μ and 300−500 μ) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Following the procedure, he developed symptoms consistent with urinary retention, paraesthesia and paresis in both lower limbs with the inability to walk. In the emergency thoracolumbar MRI performed due to suspected spinal cord ischaemia after TACE, an increased signal was observed in the distal portion of the cord and the conus medullaris with moderate restriction in the diffusion sequence (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2–4</a>), possibly related to an acute ischaemic injury at the level of T11, which was confirmed. Following rehabilitation, the patient was discharged with preserved ambulation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">TACE is based on the almost exclusively arterial vascularisation of the hepatocarcinoma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In our patient, the clinical symptoms were accounted for by the existence of an artery feeding the tumour collaterally to one of the spinal arteries that supply the spinal cord, with the chemotherapeutic material entering the spinal cord and inducing unusual transient acute spinal cord ischaemia.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1262 "Ancho" => 1262 "Tamanyo" => 150744 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Arteriography of the common hepatic artery prior to embolisation showing a tumour lesion in the right hepatic lobe (black arrow) in relation to hepatocellular carcinoma supplied by the artery of segment VI in its supero-external half.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3319 "Ancho" => 1305 "Tamanyo" => 126051 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">MRI. Sagittal plane of diffusion-weighted image showing diffusion restriction in the distal portion of the cord and conus medullaris (white arrow), possibly related to acute ischaemic injury.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1705 "Ancho" => 1306 "Tamanyo" => 125061 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">MRI. T2-weighted image with fat suppression in the sagittal plane confirming the increased signal in the indicated segments of the distal portion of the cord and conus medullaris (white arrows).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1401 "Ancho" => 1306 "Tamanyo" => 103670 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MRI. Axial T2-weighted image showing the classic “Owl's eyes” sign related to increased central signal in the context of spinal cord ischaemia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic malignancies: correlation between sonographic findings and pathological features" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Minami" 1 => "M. Kudo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4329/wjr.v2.i7.249" "Revista" => array:7 [ "tituloSerie" => "World J Radiol." "fecha" => "2010" "volumen" => "2" "numero" => "7" "paginaInicial" => "249" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21160664" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004500000009/v2_202301300757/S2444382422001602/v2_202301300757/en/main.assets" "Apartado" => array:4 [ "identificador" => "75461" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004500000009/v2_202301300757/S2444382422001602/v2_202301300757/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382422001602?idApp=UINPBA00004N" ]
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