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Acute aortic dissection presenting as painful paraplegia
B N Nandeesh1, A Mahadevan, Vani Santosh
1Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India.
Clinical Neurology and Neurosurgery
|May 4, 2007
Summary
Aortic dissection, a rare condition, can cause sudden paraplegia. This case highlights the critical need to consider aortic dissection in patients with acute paralysis and severe pain.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pathology
Background:
- Aortic dissection is a life-threatening condition characterized by a tear in the aorta's inner layer.
- Neurological complications, particularly paraplegia, are uncommon but severe manifestations of aortic dissection.
Observation:
- A 60-year-old male presented with sudden-onset paraplegia, bladder dysfunction, abdominal pain, and bradycardia.
- The patient rapidly succumbed within 14 hours of symptom onset.
- Autopsy revealed extensive DeBakey type I aortic dissection and severe atherosclerosis.
Findings:
- The aortic dissection extended from the aortic origin to the iliac bifurcation, causing medial destruction.
- Ischemic softening was observed in the spinal cord at the T12-L1 watershed zone, indicating spinal cord infarction.
- Death was attributed to cardiac tamponade, with no infarcts noted in other organs due to the rapid demise.
Implications:
- Acute aortic dissection presenting as paraplegia, though rare, must be considered in the differential diagnosis of sudden-onset paralysis.
- Prompt diagnosis and timely intervention are crucial for improving outcomes and potentially saving lives and limbs in such critical cases.
- This case underscores the importance of a high index of suspicion for aortic dissection in patients with neurological deficits and cardiovascular risk factors.
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