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Acute Aortic Dissection Presenting as Bilateral Lower Extremity Paralysis: A Case Report.
Kate E Hughes1, Colin Seguin1, Brent Felton1
1Sparrow Hospital, Lansing, Michigan.
The Journal of Emergency Medicine
|August 25, 2016
Summary
Aortic dissection, a life-threatening condition, can present with unusual symptoms like leg paralysis. Prompt diagnosis and treatment are crucial for survival in this medical emergency.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Emergency Medicine
Background:
- Aortic dissection (AD) is a critical condition with high mortality, increasing by 1% per hour if diagnosis is delayed.
- Despite surgical improvements, in-hospital mortality for AD remains substantial at 27.4%.
Observation:
- A 56-year-old woman presented with isolated lumbar pain and progressive lower extremity paralysis, initially misdiagnosed.
- Physical examination revealed cold extremities, mottling, flaccid paralysis, and sensory loss below T10.
- CT angiography confirmed an extensive Stanford type A aortic dissection.
Findings:
- Paraplegia as an initial presentation of AD, though rare (<2% of cases), results from anterior spinal artery compression and subsequent spinal cord ischemia.
- The patient underwent successful endograft stenting but unfortunately died 24 hours post-procedure.
Implications:
- Emergency physicians must maintain a high index of suspicion for aortic dissection, even with atypical presentations like paraplegia.
- Early recognition and intervention are vital for improving outcomes in patients with acute aortic dissection.
