Chest Pain and Sudden-Onset Paraplegia at the Emergency Department: An Uncommon Presentation

Abstract

Patient: Male, 45Final Diagnosis: Acute coarctation with spinal epidural hemorrhageSymptoms: Chest pain with bilateral lower limbs pareplegiaMedication: —Clinical Procedure: Percutaneous transluminal angioplasty and thoracic endovascular repair followed by bilateral hemilaminectomySpecialty: SurgeryObjective:Rare diseaseBackground:Coarctation of the aorta is characterized by narrowing of the descending aorta. The narrowing typically is at the isthmus, the segment just distal to the left subclavian artery. Adults with undiagnosed aortic coarctation are asymptomatic or may present with nonspecific hypertension. We present a case that highlights the uncommon complication of aortic coarctation with spinal compression syndrome.Case Report:A 45-year-old male presented to the emergency department (ED) with acute-onset chest pain; he experienced urinary incontinence and bilateral lower limb weakness during his ED visit. Chest CT showed coarctation of the aorta and MRI of the spine showed an epidural nodular lesion. He received emergency aortic stent placement surgery, followed by successful hematoma removal and was discharged with residual lower-extremity paraplegia.Conclusions:Chest pain with lower limb paraplegia presentation should consider aortic coarctation complicated with spinal hemorrhage as a possible cause.

Chest Pain and Hypertension from the Spinal Cord

“…Chest pain and hypertension are a common emergency indicating acute coronary syndrome or aortic dissection. However, they can also originate from the spinal cord ( 1 , 2 ). A 70-year-old Japanese man was referred to us for acute chest pain (tight, squeezing pain exacerbated when bending his back, the laterality of which could not be described).…”

“…He soon developed paraparesis and was found to have loss of pain sensation in the lower half of body (false localizing sign) ( 2 ). A Foley catheter was inserted, and a large amount of urine came out, evidence of urinary retention; this normalized his blood pressure and heart rate quickly (autonomic dysreflexia) ( 1 , 2 ). A cervical magnetic resonance imaging scan showed an epidural hematoma at the right C7 level but without vascular malformation ( Picture ).…”