Spontaneous spinal cord infarction secondary to embolism from an aortic aneurysm mimicking as cauda equina due to disc prolapse: a case report

Abstract

Spinal “stroke” is an uncommon cause of paraplegia. Spinal cord infarction from unruptured aortic aneurysm is rare. When encountered it poses diagnostic challenge to the clinician due to its rarity, which may lead to incorrect or delayed diagnosis. We report a case of 62-year-old man presenting to casualty as caudaequina syndrome due to spinal cord infarction secondary to emboli from an infra renal abdominal aortic aneurysm. To the authors knowledge this is first case of its kind and has not been reported in literature. Patient had improvement in proximal motor function following repair of the aneurysm, although he remained doubly incontinent in six months follow up.

Anterior spinal cord infarct: a rare yet disabling stroke

“…Care should be taken before making this diagnosis to rule out other more common pathologies such as inflammation or cord compression 6. The history and detailed sensory examination are key with appropriate imaging.…”

Role of diffusion-weighted MR imaging in diagnosis of spinal cord stroke following aorto-iliac bypass: Case report and review of literature

“…[1] Anterior spinal artery is narrowest at T8 level, making it most susceptible for neurovascular complications. [2] …”

“…Overall incidence of spinal cord infarct as a cause of stroke is merely 1-2%. [2,3] In the absence of history of trauma or constitutional symptoms, vascular cause should be suspected. [3].…”

Relationships Between AAA and Cauda Equina Syndrome

“…The diagnosis of dissecting aortic aneurysm was made on the basis of a CT scan. An unusual cause of spinal cord infarction, first documented in 2009 by EL-Osta et al is from emboli thrown off an abdominal aortic aneurysm (AAA), with symptoms mimicking CES [28] . An aneurysm is a focal increase in diameter of the aorta of at least 50% in relation to the normal expected diameter [29] .…”

“…The final diagnosis was through a combination of clinical, diagnostic and radiological tests. CT had shown a 6.6 by 5.8cm infra-renal aneurysm [28] . As a result of reviewing the literature, it seems that patients who are admitted with query cauda equina syndrome and with unusual symptoms, should be investigated for other causes.…”