A Diagnostic Pitfall in the Emergency Department -Aortic Dissection Masquerading as Acute Paraplegia: A Case Report

Acute aortic dissection is a life-threatening emergency with a wide spectrum of clinical presentations. Neurological deficits as the initial manifestation of aortic dissection are uncommon and may result in delayed or missed diagnosis. This case describes aortic dissection presenting primarily as acute paraplegia without persistent chest pain or other classic features.

We report a 52-year-old male who presented with sudden-onset paraplegia. Neurological examination revealed flaccid paralysis of both lower limbs, with loss of pain and temperature sensation below the first lumbar dermatome and preserved dorsal column modalities. The patient was hypertensive on presentation. A clinical diagnosis of anterior spinal artery syndrome was made. Contrast-enhanced computed tomography of the chest and abdomen demonstrated a Stanford type A aortic dissection. The patient was counseled regarding the need for urgent surgical repair but declined operative intervention and opted for conservative management. His hospital course was complicated by progressive renal failure, and he subsequently succumbed to it.

This case underscores the importance of considering aortic dissection in patients presenting with acute, nontraumatic paraplegia, even in the absence of persistent chest pain or other classic features.