Here we present a case of spinal cord ischemia involving conus medullaris as a perioperative complication of Percutaneous Coronary Intervention via Femoral Approach (PCI-FA)

Given the recent intervention via right femoral approach, a soft tissue ultrasound was obtained ruling out hematoma. MRI Lumbosacral spine showed intramedullary T2 signal hyperintensity with mild contrast enhancement of conus with subtle expansion. The para-spinal soft tissues and visualized retroperitoneum showed no abnormality.

On POD two intermittent word finding difficulty were noted and non-contrast MRI Brain showed restricted diffusion on the right posterior frontal cortex. Carotid ultrasound showed less than fifty percent stenosis of the internal carotid arteries. Transthoracic-Echo did not have abnormalities other than recent myocardial infarction. Considering the temporal relation with the PCI-FA, distribution of the cerebral infarct along with recent conus lesion – suspicion of cardiac source of embolism due to intervention was strengthened.

Acute spinal cord ischemia as a peri-operative complication of PCI-FA is very rare and limited to four case reports in English literature. To our knowledge this is the first case of ischemia of conus medullaris from PCI-FA. The proposed mechanism is thought to be atheromatous embolization from aortic instrumentation. This is particularly important to recognize as there is a risk of discounting post-procedural weakness as de-conditioning.