Paraparesis and left upper extremity weakness after total arch replacement with frozen elephant trunk: possible contributions of spinal cord ischaemia and cervical radiculopathy

Abstract

An 82-year-old man underwent total arch replacement with the frozen elephant trunk technique for an aortic arch aneurysm. Upon awakening 3 hours postoperatively, the patient exhibited flaccid paralysis of both lower extremities and left upper extremity weakness, whereas the right upper extremity was largely preserved. Cerebrospinal fluid drainage and blood pressure augmentation were initiated for suspected spinal cord ischemia. Lower-extremity motor function partially recovered, but left upper-extremity weakness persisted. Spinal magnetic resonance imaging demonstrated intramedullary T2 hyperintensity at T2/3 and bilateral neural foraminal stenosis from C3/4 to C6/7. Neurological examination revealed predominant weakness in the left C7 myotome with an absent left triceps reflexes, suggesting concomitant C7 radiculopathy. This case demonstrates that neurological deficits after aortic arch surgery may be multifactorial and highlights the value of detailed neurological examination and spinal imaging when upper extremity weakness is disproportionate.