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|Year : 2009 | Volume
| Issue : 4 | Page : 519-520
Aortic aneurysm presenting as conus-cauda syndrome
Nilesh Anil Nadkarni, Sudheer Ramattu Yousef, Kamlesh Arjundas Jagiasi, Satish V Khadilkar
Department of Neurology, Grant Medical College, Sir J. J. Hospital, Mumbai, India
|Date of Acceptance||02-Jul-2009|
|Date of Web Publication||10-Sep-2009|
Nilesh Anil Nadkarni
Department of Neurology, Grant Medical College, Sir J. J. Hospital, Mumbai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Nadkarni NA, Yousef SR, Jagiasi KA, Khadilkar SV. Aortic aneurysm presenting as conus-cauda syndrome. Neurol India 2009;57:519-20
A 65-year-old male developed retention of urine and constipation followed by subacute progressive weakness in both lower limbs. He had trauma to his back in childhood, when a wall of his house had collapsed on him without causing any deficit. On examination, he had gibbus from D11 to L2 vertebrae [Figure 1]. Sensorimotor loss affecting L1 to S1 segments on either side, but more prominent in the L4-S1 distribution, was present. A clinical diagnosis of conus-cauda syndrome was made. MRI of dorso-lumbar spine showed a saccular aneurysm arising from posterior wall of thoraco-abdominal aorta from D11-L2 level [Figure 2]a and b. There was calcification of the aneurysmal wall and its lumen contained a large eccentric lamellated thrombus. The aneurysm extended into the spinal canal by destroying D12 and L1 vertebral bodies and compressed the conus medullaris [Figure 2]b. On CT aortography, the aneurysm was 6.8 × 6.5 × 5.8 cm 3 in dimensions [Figure 3]a and b.
The patient was nonhypertensive. His serum venereal disease research laboratory (VDRL) test was negative and he had no features suggesting disorders of collagen formation. Cause of the aneurysm could not be ascertained.
Conus-cauda lesion is a rare complication of aortic aneurysm. A case of transient paraparesis as complication of an acute abdominal aortic aneurysm rupture, presumably due to occlusion of blood flow to conus medullaris, has been described.  Some cases have resulted as complications of open as also endovascular aneurysmorraphy.  This case highlights an unusual cause of conus cauda syndrome. Remission of paraparesis following aneurysmorraphy and spinal column repair can occur.  However, our patient did not opt for it.
| » Acknowledgment|| |
We acknowledge the contribution of Radiology Department, Sir J. J. Hospital, to this case.
| » References|| |
|1.||Kamano S, Yonezawa I, Arai Y, Iizuka Y, Kurosawa H. Acute abdominal aortic aneurysm rupture presenting as transient paralysis of the lower leg: A case report. J Emerg Med 2005; 29:53-5. |
|2.||Maldonado TS, Rockman CB, Riles E, Diah D, Addman MA, Jacobowitz GR, et al. Ischaemic complications after endovascular abdominal aortic aneurysm repair. J Vasc Surg 2004; 40:703-10. |
|3.||Forutan H, Herdmann J, Huber R, Saleh A, Steiger HJ, Sandmann W. Paraparesis due to pressure erosion of the thoracic spine by an aortic aneurysm: Remission of symptoms following resection of the aneurysm and vertebral reconstruction. Acta Neurochir (Wien) 2004; 146:303-8. |
[Figure 1], [Figure 2], [Figure 3]