Acute spinal cord ischemia: treatment with intravenous and intra-arterial thrombolysis, hyperbaric oxygen and hypothermia.

A 58-year-old man with a medical history of hypertension and hepatocellular carcinoma status after liver transplantation 2 years previously developed head and neck pain. Computed tomography (CT) revealed a contrast enhancing C2 vertebral body metastasis. The highly vascular lesion was embolized prior to surgical resection to minimize surgical complications. The diagnostic angiogram revealed a hypervascular lesion fed by the artery of C1 , C 2 and C3 of the nondominant right vertebral artery (VA; fig. 1). The artery of cervical enlargement feeding the anterior spinal artery was identified at the level of C5. Prior to the VA take-down, a balloon test occlusion was performed without any adverse events. Coil embolization from C1 to C2, followed by xylocaine testing and mannitol/polyvinyl alcohol 250–350 μm embolization of the hypervascular lesion at C2 was done. Subsequently, coil embolization for VA take-down was performed to the level of C3.