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Case report: left monoplegia in acute type B aortic dissection.

Hyunsoo Kim1, Woon Heo2,3, Suk-Won Song3

  • 1Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

AME Case Reports
|August 15, 2020
PubMed
Summary

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Acute type B aortic dissection (ATBAD) can cause rare spinal cord ischemia leading to monoplegia. Endovascular fenestration effectively restored blood flow and neurological function in a patient with ATBAD-induced leg paralysis.

Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Medicine

Background:

  • Acute type B aortic dissection (ATBAD) is a serious condition that can lead to malperfusion.
  • Spinal cord ischemia is a rare but devastating complication of ATBAD, with monoplegia being exceptionally infrequent.

Observation:

  • A 62-year-old male presented with chest pain and left lower extremity weakness due to ATBAD involving multiple arterial branches.
  • CT imaging revealed dissection from the left subclavian artery to the iliac bifurcation, causing malperfusion of renal, intercostal, and lumbar arteries.

Findings:

  • Endovascular fenestration was performed to enlarge the dissection tear, improving true lumen flow in the descending aorta.
  • Post-procedure angiography and CT confirmed restored blood flow to the compromised renal, intercostal, and lumbar arteries.
Keywords:
Case reportacute type B aortic dissection (ATBAD)endovascular fenestrationmonoplegiaspinal cord ischemia

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  • The patient experienced complete recovery of sensory and motor function in the left leg.

    • Implications:

    • This case highlights the rarity of ATBAD-induced monoplegia.
    • Endovascular fenestration presents a viable and effective treatment strategy for spinal cord ischemia secondary to ATBAD.
    • Successful treatment led to rapid functional recovery and positive patient outcomes.