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Painless aortic dissection presenting as spinal cord ischemia.

S A Rosen1

  • 1Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, Maryland 21205.

Annals of Emergency Medicine
|August 1, 1988
PubMed
Summary

Painless acute aortic dissection can cause temporary leg paralysis (paraplegia). This rare presentation highlights the need to consider aortic dissection in patients with unexplained spinal cord issues.

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Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Vascular Surgery

Background:

  • Acute aortic dissection (AAD) is a life-threatening condition often presenting with severe chest or abdominal pain.
  • Neurological deficits can occur in AAD due to spinal cord ischemia, but transient paraplegia as the sole initial symptom is rare.

Observation:

  • A 67-year-old woman presented with sudden, transient paraplegia without any reported chest or abdominal pain.
  • Advanced imaging revealed extensive aortic dissection involving the aortic root, arch, and descending aorta, along with pericardial effusion.
  • Abdominal ultrasonography identified an intimal flap near the artery of Adamkiewicz, suggesting spinal artery compromise.

Findings:

  • The patient's transient paraplegia was attributed to temporary obstruction of spinal arteries secondary to the aortic dissection.
  • This case demonstrates that aortic dissection can manifest neurologically without typical pain symptoms.

Implications:

  • Painless aortic dissection should be included in the differential diagnosis for patients presenting with acute, transient myelopathy or paraplegia.
  • Early recognition of this atypical presentation is crucial for timely intervention and improved patient outcomes.
  • Highlights the importance of comprehensive vascular and neurological assessment in unexplained myelopathy.

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