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Painless aortic dissection presenting as high paraplegia: a case report
E M Donovan1, G K Seidel, A Cohen
1Rehabilitation Institute of Michigan, Detroit, USA.
Archives of Physical Medicine and Rehabilitation
|October 13, 2000
Summary
A rare case of painless aortic dissection presented as acute paraplegia in a 77-year-old woman. This highlights the importance of considering aortic dissection in new-onset paralysis, even without typical chest pain.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Acute aortic dissection is a life-threatening condition often presenting with severe chest or back pain.
- Neurologic complications occur in up to one-third of patients with aortic dissection.
- Painless aortic dissection is rare, accounting for approximately 5% of cases.
Observation:
- A 77-year-old woman presented with acute paraplegia but denied any chest or back pain.
- Physical examination revealed complete loss of motor function and sensation in the lower extremities.
- Computed tomography confirmed a type A dissecting aneurysm.
Findings:
- The patient's presentation mimicked spinal cord injury, with absent lower extremity strength, reflexes, and sensation.
- The diagnosis of aortic dissection was established despite the absence of typical pain symptoms.
- The case underscores the potential for aortic dissection to manifest solely with neurologic deficits.
Implications:
- This case emphasizes the need to include aortic dissection in the differential diagnosis for acute-onset paraplegia.
- Understanding the vascular supply to the spinal cord is crucial for diagnosing and managing such cases.
- Early recognition and intervention are critical for improving outcomes in patients with aortic dissection presenting with neurologic symptoms.