Ischaemic lumbosacral plexopathy following aortic dissection.

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Anatomy

Background:

• Acute myocardial infarction and Stanford type A aortic dissection pose significant surgical challenges.
• Vascular complications following aortic repair, such as limb ischemia, require prompt recognition and management.

Observation:

• A 57-year-old male presented with acute myocardial infarction and extensive aortic dissection.
• Post-Bentall procedure, the patient developed acute neurological deficits in the left leg, including weakness and sensory loss.
• Clinical examination revealed hypotonia, absent deep tendon reflexes, and significant motor deficits (MRC 0/5 distal, 3/5 proximal).

Findings:

• Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus.
• MR imaging demonstrated diffuse muscle edema in the left gluteus maximus, consistent with ischemic injury.
• The diagnosis of ischemic lumbosacral plexopathy was established, secondary to aortic dissection and internal iliac artery occlusion.

Implications:

• This case highlights the potential for ischemic plexopathy as a complication of extensive aortic dissection and repair.
• Understanding the vascular anatomy of the lumbosacral plexus is crucial for diagnosing and managing such rare neurological sequelae.
• Early recognition and diagnostic workup, including electrodiagnostic studies and advanced imaging, are essential for appropriate patient care.