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The Other Aortic Syndrome-Intramural Hematoma and Neurological Deficit: Case Report
Laura E Walker1, Chris Marcellino2,3, Bhargavi Gali4,2
1Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Clinical Practice and Cases in Emergency Medicine
|March 28, 2024
Summary
Acute thoracic aortic syndromes, like aortic intramural hematoma, can cause neurological deficits. Prompt diagnosis and blood pressure management are crucial for spinal cord perfusion.
Area of Science:
- Emergency Medicine
- Cardiology
- Neurology
Background:
- Acute thoracic aortic syndromes (ATAS) present significant morbidity and mortality risks.
- Thoracic aortic dissection is the most common ATAS, followed by penetrating aortic ulcers and aortic intramural hematomas.
Purpose of the Study:
- To report a case of aortic intramural hematoma presenting with neurological deficits.
- To highlight the importance of rapid diagnosis and management in preventing spinal cord ischemia.
Main Methods:
- Case presentation of a 67-year-old woman with chest/back pain and paraparesis.
- Diagnosis of aortic intramural hematoma via imaging.
- Management included spinal drain placement and blood pressure control.
Main Results:
- The patient presented with symptoms suggestive of spinal cord compromise.
- Aortic intramural hematoma was diagnosed.
- Intervention focused on optimizing spinal cord perfusion.
Conclusions:
- Neurological deficits in ATAS necessitate urgent diagnosis of spinal ischemia.
- Blood pressure optimization is vital for spinal cord perfusion.
- Spinal drains can be a valuable adjunctive treatment in select cases.
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