Acute aortic dissection presenting as painless paraplegia: a case report

Abstract

BackgroundAcute aortic dissection is an extreme emergency that is generally manifested by violent chest pain irradiating to a patient’s back and abdomen. Paraplegia due to spinal cord ischemia and infarction as a presenting manifestation of aortic dissection has been found in 2 to 5 % of patients. However, painless paraplegia is exceedingly rare and limited to a few case reports in the literature. We describe a new case with this unusual presentation of aortic dissection and here we emphasize that this condition must be considered in all patients with painless paraplegia.Case presentationA 70-year-old Arab man with no previous known medical or surgical conditions was hospitalized for brutal heaviness of his lower limbs associated to urinary retention. A neurological examination revealed flaccid paraplegia without sensory disorder. His blood pressure and his pulse were in normal ranges. He was afebrile. His peripheral pulses were not checked. Laboratory investigations eliminated multiple organ failure. Spinal magnetic resonance imaging realized in emergency was normal. He had a cardiopulmonary arrest 1 day after his hospitalization. His autopsy report concluded a type A aortic dissection with an intimal tear at his aortic isthmus with intrapericardial rupture and extension to his intercostal and lumbar arteries.ConclusionsAcute aortic dissection is an extreme emergency that can lead to death unless there is an early diagnosis. It must be considered in any patient with paraplegia even painless. Clinical examination has a major role to play in diagnosing this condition. Apart from the neurological examination, palpation of peripheral pulses and blood pressure measurements in all four limbs is of paramount importance. Then further investigations must be carried out consisting of aortic angiography by computed tomography or by magnetic resonance imaging.

More than just muscle spasms: a rare presentation of aortic dissection

“…A similar neurological presentation was recently seen in a 70-year-old patient with heaviness in bilateral lower limbs, flaccid paraplegia with urinary retention who was diagnosed with an acute aortic dissection 6. Kowalska-Brozda and Brozda7 presented a case of bilateral stroke in which the patient was eventually diagnosed with an underlying acute aortic dissection.…”

Spinal Cord Infarction with Aortic Dissection

“…Patients with acute aortic dissection often complain of back pain that has a tearing or ripping quality. However, there are some reports of aortic dissection presenting with little or no pain [ 4 , 5 ]. Classical symptoms of aortic dissection have been reported to be absent in up to 10% of patients [ 6 ].…”

A Case of Acute Paraplegia Due to Aortic Dissection in Marfan Syndrome

“…The annual incidence of AD is 27–32 per million,[ 2 8 ] bearing high mortality (80%). [ 1 5 ] The high-risk population includes the patients with advanced age, chronic hypertension (70%–80%), Marfan syndrome (5%–9%), Turner's syndrome, Ehlers–Danlos syndrome, aortic aneurysm, annuloaortic ectasia, aortic arch hypoplasia, coarctation of aorta, bicuspid aortic valve (7%–14%), connective tissue disorders, cocaine abuse, and atherosclerosis.…”

“…[ 1 ] Furthermore, paraplegia as a presenting manifestation of AD is rare. [ 2 ] Other differential diagnoses of spinal arteriovenous malformation, dural arteriovenous fistula, epidural abscess, and spinal cord demyelination were also considered. However, a single consolidated diagnosis which explains all the findings Could not be arrived at this point.…”