Paraplegia after spontaneous dissection of the abdominal aorta

We report a case with spinal cord ischemia and consecutive paraplegia following spontaneous isolated abdominal aortic dissection (IAAD). A 63-year-old female was admitted to the surgical emergency room with severe lumbar back pain and accompanying paresthesia of both legs. Contrast enhanced computed tomograpy (CT) of the abdomen showed an infrarenal IAAD in a normal size aorta with patent lumbar arteries. It was assumed that a surgical or interventional approach would not be helpful to improve spinal cord perfusion. Therefore, non operative therapy consisted of lowering blood pressure to prevent further dissection. The patient developed an anterior spinal artery syndrome with permanent paraplegia. Thus, blood pressure was raised for optimal spinal cord perfusion. To lower the spinal pressure, cerebrospinal fluid drainage was attempted. A three month follow-up CT scan showed spontaneous remodelling of the aorta. The neurological deficit persisted. IAAD is a rare differential diagnosis of lumbar back pain and can be associated with paraplegia as the leading symptom. Individualized treatment is indicated. Surgical treatment options concerning paraplegia are limited.