Acute paraplegia in painless aortic dissection. Rich imaging with poor outcome

Case report.

To describe the clinical and imaging findings of a patient with painless aortic dissection.

University Neurology Department, Thessaloniki, Greece. PATIENT, METHODS, RESULTS: A 46-year-old man was transferred to our Department for emergent evaluation of paraplegia, from the local hospital of the nearby town, where he was admitted complaining from sudden, painless, bilateral leg weakness, 24 h earlier. He presented complete flaccid paraplegia with urinary retention, loss of pain and temperature sensation below the TH7 level and well-preserved vibration and position sense bilaterally. He had no pain and general physical examination was unremarkable. Chest X-rays first raised the suspicion of an aortic lesion. Thoracic MRI revealed cord dilation, with no enhancement on T1-weighted images (wi) and increased signal on T2-wi at the TH9-TH12 levels, suggesting cord ischemia. At the same MR sequences, the double lumen of the descending aorta indicated dissection in both sagittal and axial images. Later the same day, the patient died, and autopsy verified dissection of the descending aorta up to the aortic valve.

The rapid evolution of our case further points out that radiologists, neurologists, as well as internal specialists should be vigilant for this emergency, which despite rich imaging could have a fatal outcome.