J Korean Neurosurg Soc.  2014 Mar;55(3):156-159. 10.3340/jkns.2014.55.3.156.

Paraplegia due to Acute Aortic Coarctation and Occlusion

• Park CB
• Jo DJ
• Kim MK
• Kim SH

• KMID: 2191082
• DOI: http://doi.org/10.3340/jkns.2014.55.3.156

Abstract

Coarctation and occlusion of the aorta is a rare condition that typically presents with hypertension or cardiac failure. However, neuropathy or myelopathy may be the presenting features of the condition when an intraspinal subarachnoid hemorrhage has compressed the spinal cord causing ischemia. We report two cases of middle-aged males who developed acute non-traumatic paraplegia. Undiagnosed congenital abnormalities, such as aortic coarctation and occlusion, should be considered for patients presenting with nontraumatic paraplegia in the absence of other identifiable causes. Our cases suggest that spinal cord ischemia resulting from acute spinal subarachnoid hemorrhage and can cause paraplegia, and that clinicians must carefully examine patients presenting with nontraumatic paraplegia because misdiagnosis can delay initiation of the appropriate treatment.

Keyword

Paraplegia; Aortic coarctation; Aortic occlusion; Spinal cord ischemia

MeSH Terms

Aorta
Aortic Coarctation*
Congenital Abnormalities
Diagnostic Errors
Heart Failure
Humans
Hypertension
Ischemia
Male
Paraplegia*
Spinal Cord
Spinal Cord Diseases
Spinal Cord Ischemia
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Magnetic resonance imaging reveals a large acute spinal subarachnoid hematoma extending from C2 to T4 with spinal cord compression and numerous dilated anterior spinal arteries at the C6--T3 levels (white asterisk).

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  Fig. 2 The computed tomography angiogram reveals a tortuous aortic coarctation (white arrow) with an extensive network of collaterals (arrowheads).

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  Fig. 3 Preoperative radiographs. Lateral lumbar spine radiograph (A) shows some spondylosis with aortic calcification (arrows). Lumbar CT (B and C) shows spondylolysis on L5 (arrows). T2-weighted MRI (D) reveals disc degeneration of L4--5 and L5--S1 without compressive lesion of the spinal cord or cord swelling.

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  Fig. 4 The patient exhibited pallor and livedo reticularis in his lower extremities.

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  Fig. 5 The axial computed tomography angiography of the abdominal aorta and lower extremities reveal aortoiliac thrombotic occlusion (large arrow) and renal infarction (small arrows).

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