Spinal-cardiac crosstalk

Excerpt

In the context of multiple drug intoxication (alprazolam, tramadol and alcohol), a 43-year-old female was admitted to our ICU for hypotension, alteration of consciousness and C4-level tetraplegia. She was found unconscious with her neck in prolonged hyperflexion (90°) for at least 12-h. Oro-tracheal intubation was performed for respiratory failure. A spinal MRI showed cervical myelitis, major para-vertebral and muscular edema facing the lesion (Fig. 1) while echocardiography found an aspect of stress-induced cardiomyopathy with development of a refractory cardiogenic-shock requiring venoarterial-ECMO. She recovered a normal cardiac function and consciousness with persistence of C4-tetraplegia and mechanical ventilation dependency due to central diaphragm paralysis. The cerebrospinal fluid showed a mild hyperproteinorachy without leukocytes, auto anti-body, IgG intrathecal synthesis, or viral genome detection. In addition, cerebral MRI was normal. Despite corticosteroid bolus, her neurological condition did not improve and she passed away from ventilator-associated pneumonia one month later.

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