Acute Intramural Hematoma of the Aorta Complicated by Spinal Cord Ischemia

Yu, Pey‐Jen; Cassiere, Hugh A.; Liang, Danny

doi:10.1111/jocs.12199

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…To our knowledge, there have been only six other cases described in the literature besides our case (Table 2 ) [ 38 , 39 , 40 , 41 , 42 , 43 ]. For the first time, in 1996, Ferguson et al [ 38 ] reported a case of IMH with spinal cord ischemia in a 62-year-old hypertensive male.…”

Section: ⧉ Discussionmentioning

confidence: 85%

Spinal cord infarction caused by extensive aortic intramural hematoma

Diaconu

Neagoe²,

Donoiu³

et al. 2021

Rom J Morphol Embryol

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We report the case of a 62-year-old Caucasian man, an ex-smoker, who presented to the emergency room complaining of intense lower back pain followed by immediate bilateral loss of inferior limbs motor function. Clinical examination showed complete paralysis and paranesthesia in both legs, while pain and temperature sensory examination revealed a sensory level at dermatome T6, with normal touch, vibration, and position senses. His blood pressure was 190/100 mmHg. Computed tomography demonstrated dilated thoracic aorta (maximum diameter 44 mm) and abdominal aorta (maximum 58 mm), with extended intramural hematoma (IMH), thus establishing the diagnosis of type A aortic IMH complicated with paraplegia through spinal perfusion deficit. Due to the extension of the lesions, surgical intervention for aortic repair was considered at high risk while cerebrospinal fluid drainage was not recommended by the neurologist. The patient remained stable while hospitalized and was released from the hospital with mild improvement of neurological deficiencies.

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Section: ⧉ Discussionmentioning

confidence: 85%

Spinal cord infarction caused by extensive aortic intramural hematoma

Diaconu

Neagoe²,

Donoiu³

et al. 2021

Rom J Morphol Embryol

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“…Spinal cord infarction is rare, occurring in ~2% of cases of AD and is typically due to disruption of the vascular network supplying the spinal cord [7,18]. Ischaemic spinal cord injury has been described in a few cases of IMH, with some variability in symptom severity, but to the best of our knowledge BSS has never been described [8][9][10][19][20][21][22]. In this case, the findings on clinical examination correlate with the radiological findings, with the T12 sensory level corresponding to the thoracic segment of the IMH, and is near the region that was worst affected, and the evolving aortic ulcer.…”

Section: Discussionmentioning

confidence: 99%

Neurological presentation of acute aortic syndrome: Type A intramural haematoma presenting as ischaemic hemisection of the spinal cord

Seet

Walker

Lyons

et al. 2020

Spinal Cord Ser Cases

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Introduction Intramural haematoma (IMH) describes the presence of blood within the aortic wall, and is associated with a significant morbidity and mortality. Early diagnosis is essential for institution of medical, and sometimes surgical, management. Neurological complications have rarely been described during the initial presentation of IMH, or other forms of acute aortic syndrome. Case presentation We describe a 56-year-old man who presented with sudden onset chest pain and left leg weakness and numbness, and the loss of right leg pain and temperature sensation. CT Angiography showed a Type A intramural haematoma extending from the ascending to the infra-renal aorta. He was managed successfully with cerebrospinal fluid drainage and thoracic endografting to cover the intimal entry lesion. His neurological symptoms improved and he remained well at 3 years with minor residual neurological deficits. Discussion Spinal cord infarction is a rare but documented complication of acute aortic syndrome; Brown-Séquard syndrome typically results from a traumatic injury. To the best of our knowledge, this is the first report of IMH presenting with Brown-Séquard syndrome. This case highlights the need to consider acute aortic syndromes in a patient presenting with chest pain and acute neurological symptoms.

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Acute Intramural Hematoma of the Aorta Complicated by Spinal Cord Ischemia

Abstract: We present an unusual case of spinal cord ischemia from an acute type B intramural hematoma that was successfully treated with blood pressure elevation and drainage of cerebral spinal fluid.

Cited by 2 publications

References 8 publications

Spinal cord infarction caused by extensive aortic intramural hematoma

Spinal cord infarction caused by extensive aortic intramural hematoma

Neurological presentation of acute aortic syndrome: Type A intramural haematoma presenting as ischaemic hemisection of the spinal cord

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