Spinal cord infarction resulting from intramural haematoma of the thoracic aorta

We present the case of a female patient in her 60s with multiple medical comorbidities who presented to the emergency department with sudden-onset tearing chest, back and abdominal pain in the setting of a hypertensive emergency. Initial CT-angiography demonstrated mild-diffuse thickening of thoracic and abdominal aorta without signs of intramural haematoma or dissection. The patient was subsequently admitted and medically managed. In the days following admission, the patient developed a small bowel obstruction and neurological deficits. Repeat imaging demonstrated an intramural haematoma extending from left subclavian artery to the diaphragm resulting in foci of spinal cord infarction. Instances of spinal cord infarction secondary to aortic intramural haematoma are rare, with a minority of cases reported as of 2020. This case report highlights a non-classic patient presentation of an intramural haematoma, shedding light onto possible clinical outcomes, treatment options and important risk factors.