Cauda equina syndrome versus saddle embolism

Abstract

We discuss a case of saddle embolism with a clinical presentation similar to cauda equina syndrome in a 79-year-old woman with a history of ischaemic heart disease. Saddle embolus is very rare but one of an array of visceral causes for back and leg pain. This case highlights diagnostic difficulties, particularly in patients with multiple disorders. A high index of suspicion for vascular conditions must be exercised in cases of arterial dysfunction presenting with back pain.

A case study on thrombolytic treatment of acute aortic saddle embolism using bilateral femoral arterial puncture catheter

“…When symptoms of limb ischemia, such as paresthesia and paralysis, occur for 6 h, there is a chance of limb necrosis. If these symptoms occur beyond 10–12 h, even after restoring blood flow, irreversible limb damage cannot be avoided 10 . Postoperative ischemia/reperfusion (I/R) injury and MMS are the main causes of death.…”

Acute Paraplegia as a Presentation of Aortic Saddle Embolism

“…In approximately 85% of patients the GRA originates on the left side of the aorta at the level of seventh through twelfth thoracic vertebra [17]. In the remaining patients a low point of origin of the GRA may occur at the level of L3 (1.4%) or L4-L5 (0.2%) with the balance of the vascular supply provided by the anastomotic arterial ansa of the conus at L1–L5 supplied by the pelvic vasculature [18]. It is therefore unlikely that a distal aortic saddle embolism would result in spinal cord ischemia unless the obstruction is exceedingly long and completely occlusive or if the origin of the GRA is abnormally low [16].…”

Acute aortic occlusion with sudden paraplegia secondary to Aspergillus niger embolism from Aspergillus niger aortitis

“…Such neurologic signs have been implicated in the delay in diagnosis of acute aortic occlusion found in some studies, with patients incorrectly referred for neurologic consultations despite clear evidence of vascular compromise. 3 Sudden paraplegia is much less common and is thought to be related to the acute occlusion of the origin of artery of Adamkiewicz and supplementary arterial ansa of the conus. 4 The presence of neurologic compromise is associated with a higher mortality rate.…”