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Table of Contents    
NEUROIMAGE
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1127-1128

“Acute Onset Paraplegia—Look at the Aorta, if Spinal Cord Imaging is Normal”


Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India

Date of Submission15-Oct-2019
Date of Decision22-Jan-2020
Date of Acceptance14-Jul-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Thomas Mathew
Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.325372

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How to cite this article:
Mathew T, John SK, Sharath Kumar G G. “Acute Onset Paraplegia—Look at the Aorta, if Spinal Cord Imaging is Normal”. Neurol India 2021;69:1127-8

How to cite this URL:
Mathew T, John SK, Sharath Kumar G G. “Acute Onset Paraplegia—Look at the Aorta, if Spinal Cord Imaging is Normal”. Neurol India [serial online] 2021 [cited 2021 Oct 23];69:1127-8. Available from: https://www.neurologyindia.com/text.asp?2021/69/4/1127/325372




A 64 years old male, a security guard by occupation, a chronic smoker, presented with sudden onset severe back pain followed by acute onset bilateral lower limb weakness and numbness. On examination, the patient had accelerated hypertension with well felt peripheral pulses. Blood pressure in the right upper limb was 190/110 mmHg and in left upper limb was 104/100 mmHg. Neurological examination revealed flaccid paraplegia with absent touch, pain, and temperature with a sensory level of T10 but preserved proprioception. Clinically, a provisional diagnosis of the anterior spinal artery occlusion was made. MRI of the spine showed normal cord parenchyma. However, on careful evaluation of MRI, a double-barrel aorta was observed with intramural thrombus in the false lumen, from the arch of aorta up to bilateral common iliac artery [Figure 1] and [Figure 2] which confirmed the diagnosis of anterior spinal artery occlusion secondary to aortic dissection.
Figure 1: MRI spine axial section showing double-barrel aorta (red arrow) with true and false lumen and normal spinal cord

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Figure 2: MRI spine sagittal section showing double-barrel aorta (red arrow) with true and false lumen

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Acute onset paraplegia can be a presenting manifestation of aortic dissection in 3–5% of the patients.[1] These aortic dissections can be painful or painless, and in many case reports, classical back or chest pain was conspicuously absent.[2],[3],[4],[5] As MRI signal changes in anterior spinal artery occlusion may be delayed for a few days,[6] it is prudent to look at aortic lumen for any dissection or thrombosis. Aortic dissection being one of the known causes of the anterior cord syndrome, aorta should always be examined while evaluating the imaging in suspected cases of anterior spinal artery occlusion.

Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Inamasu J, Hori S, Yokoyama M, Funabiki T, Aoki K, Aikawa N. Paraplegia caused by painless acute aortic dissection. Spinal Cord 2000;38:702-4.  Back to cited text no. 1
    
2.
Colak N, Nazli Y, Alpay MF, Akkaya IO, Cakir O. Painless aortic dissection presenting as paraplegia. Tex Heart Inst J 2012;39:273-6.  Back to cited text no. 2
    
3.
Zull DN, Cydulka R. Acute paraplegia: A presenting manifestation of aortic dissection. Am J Med 1988;84:765-70.  Back to cited text no. 3
    
4.
Kawabata A, Tomori M, Arai Y. Spinal cord infarction with aortic dissection. Case Rep Orthop 2018;1-4.  Back to cited text no. 4
    
5.
Hdiji O, Bouzidi N, Damak M, Mhiri C. Acute aortic dissection presenting as painless paraplegia: A case report. J Med Case Rep 2016;10:99.  Back to cited text no. 5
    
6.
Kouki S, Labben E, Abdallah NB. Acute spinal cord infarction after aortobifemoral bypass. Neurol India 2017;65:1128-30.  Back to cited text no. 6
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