Aortic Dissection presenting with Paraplegia: A Case Report

Introduction: Aortic dissection typically presents as severe chest or back pain. However, as a great mimicker, it can also manifest with various clinical presentations.

Presentation of case: A 70-year old male presented with sudden onset bilateral lower extremity weakness while defecating, and associated with lower back pain. Symptoms progressed to bilateral lower extremity paralysis and sensory loss up to the inguinal area. CT angiogram showed aortic dissection from the root down to the proximal abdominal aorta just before the origin of the renal arteries. There is non-opacification of the right axillary artery and left vertebral artery. This confirmed the diagnosis of acute aortic dissection resulting to spinal cord ischema.

Discussion: The spinal ischemia resulted probably from further expansion of the false lumen and compromised blood flow to the brachiocephalic, subclavian and radicular arteries.The incidence of spinal cord infarction with aortic dissection is reported to be 4 percent while spinal cord ischemia as the presenting symptom of aortic dissection is even more unusual.

Conclusion: Aortic dissection should be included in the differential diagnosis of patients presenting with acute spinal syndromes.