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[Paraplegia after acute thoracic pain]
T Kleinfeldt1, T C Rehders, U Raab
1Klinik und Poliklinik für Innere Medizin, Universität Rostock, Ernst-Heydemannstrasse 6, 18057 Rostock. tilo.kleinfeldt@gmx.de
Der Internist
|December 13, 2005
Summary
Delayed paraplegia after acute aortic dissection can occur due to intramyelon bleeding, not just aortic dissection itself. This case highlights alternative mechanisms for spinal cord complications.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Radiology
Background:
- Acute aortic dissection (AAD) is a life-threatening condition.
- Neurological complications, including spinal cord ischemia and paraplegia, occur in approximately 3% of AAD cases.
- The exact mechanisms leading to paraplegia in AAD are not fully understood.
Observation:
- A 67-year-old patient presented with acute chest pain followed by delayed onset paraplegia 8 hours later.
- Contrast-enhanced computed tomography revealed a Stanford type B aortic dissection.
- Magnetic resonance imaging identified an intraspinal intraaxial hematoma of the spinal cord.
Findings:
- The patient's paraplegia was attributed to an intramyelon hematoma.
- This hematoma preceded the aortic dissection, suggesting an alternative cause for the neurological deficit.
- The aortic dissection was limited to a short segment of the aorta.
Implications:
- This case underscores that paraplegia in the context of acute aortic dissection may arise from mechanisms other than direct aortic compromise.
- Intramyelon bleeding should be considered as a potential cause of paraplegia, even in patients with aortic dissection.
- Prompt and accurate diagnosis using advanced imaging is crucial for appropriate management of neurological complications in AAD.