1247 - Beware of Rising Water Levels: A Case of Lower Motor Neuron Bladder in Thoracic Infarct

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

BF

Brent Fogel, DO

Resident Physician
Northwell LIJ Forest Hills/NUMC
Rego Park, New York, United States

Co-Author(s)

CV

Caroline A. Varlotta, DO

Resident Physician
Mount Sinai Hospital
Scarsdale, New York, United States

Corresponding Author(s)

VH

Vincent Huang, MD

Associate Professor
Mount Sinai Hospital
New York City, New York, United States

Case Diagnosis: Spinal cord infarct secondary to thoracoabdominal aneurysm repair complicated by Lower Motor Neuron bladder dysfunction

Case Description: A 64 year old male with history of A/B aortic dissection requiring ascending aorta repair followed by re-do sternotomy, debranching and arch repair w/ TEVAR complicated by persistent Type II endoleak status post coil embolization x2 for false lumen. After the patient underwent thoracoabdominal aneurysm repair, MRI of the lumbar spine showed signal intensity throughout the distal spinal cord, thinning of conus medullaris suspicious for cord infarction, with no cauda equina compression or arachnoiditis. Subsequent MRI of the thoracic spine demonstrated evolving infarction of T7-L1. On admission to the acute rehab floor, the patient had bilateral lower extremity paralysis and primarily LMN bladder dysfunction.

Discussions: In the setting of cord infarct, a patient can commonly present with an UMN or mixed picture bladder dysfunction. However, in this instance the patient displayed failure to empty, which indicates LMN bladder dysfunction. Voiding can be difficult due to increased tension of the internal sphincter, however urine leakage may occur secondary to overflow incontinence. Cystometrogram and EMG can provide evidence of lower motor neuron dysfunction. Providing adequate bladder management is important since UTI’s and hydronephrosis are potential issues that can plague this patient population. Management includes bladder scans with intermittent catheterization, which was utilized in this patient, and techniques such as the Crede maneuver.

Conclusions: It is critical for physiatrists to recognize the possibility of LMN bladder dysfunction in post-operative vascular patients. Spinal cord infarcts are rare and may present as a LMN spinal cord injury, which drastically changes bladder management. It is important for physiatrists to understand the nuance of cord infarcts and recognize who displays LMN deficits so they can further manage these patients appropriately.