LAUSR

with transcranial Doppler thrice a day which showed normal mean flow velocities. On the third postoperative day, the patient developed paraparesis in lower limbs (power 3/5). Transcranial Doppler showed mild increase in right ACA velocities and noncontrast computerized tomography showed no fresh changes. Anticipating cerebral vasospasm in the ACA, the patient was taken up for digital subtraction angiography which showed mild vasospasm in ACA. Intra-arterial nimodipine 3 mg and milrinone 8 mg were administered over 1 hour. Postprocedure condition further worsened (power 1/5). The magnetic resonance imaging diffusion weighted imaging revealed central intramedullary acute ischemic changes from conus medullaris to D8 (Figs. 1 and 2). Although controversial, the lower range of MAP to maintain autoregulation of spinal cord blood flow and renal perfusion has been estimated at 60 to 80mmHg. 1,2 In our patient, perfusion above the coarctation was monitored by invasive radial line and below the coarctation through adequate urine output. In our patient, we maintained the MAP slightly on the lower side because of concern for the development of carotid hematoma and incomplete securing of the aneurysm. Determining what the target BP should be for a particular patient is difficult because of pathology and comorbidities. On the basis of the poor outcome in this patient, we recommend maintaining BP at preoperative values and monitoring the patients BP via 2 arterial lines that is, one above and one below the stenotic lesion. 3 Separate pulse oximetry monitoring for upper and lower limbs also would be useful.