Acute Spinal Cord Ischemia: Treatment with Intravenous and Intra-Arterial Thrombolysis, Hyperbaric Oxygen and Hypothermia

nificant improvement in motor function (3 out of 5 on the motor deficit score on the right upper extremity and 2 out of 5 on the right lower extremity). MRI with diffusion-weighted image showed a restricted diffusion in the right-sided anterolateral spinal cord ( fig. 5 ). Because of the immediate clinical improvement after the first treatment, the patient received the second HBO treatment in 12 h but did not have further improvement after the second treatment. Starting 24 h after the onset of symptoms, the patient then received induced hypothermia for 24 h using a surface-cooling device (Arctic Sun, Medivance Inc.). The target temperature was set at 33 ° C. Shivering was treated with intravenous dexmeditomidine, magnesium and propofol sedation. Passive rewarming was performed at a rate of 0.2 ° C/h after 24 h of hypothermia. After cooling, the patient was noted to have a significant neurological improvement in strength on the right side as well as his sensory deficit on the left side of his body. His motor scale improved to 4 out of 5 on both right upper and lower extremities. The sensory deficit completely disappeared, and he was able to feel both pinprick and temperature sensations. Three weeks later, he was able to walk without assistance and regained all of his strength in his right arm with minimal residual weakness in his right leg. There was no sensory deficit to any sensory modalities on either side of his body.