Paraplegia caused by painless acute aortic dissection.
OBJECTIVE
Painless acute aortic dissection in which paraplegia is the only presenting sign is rare, with limited reported cases.


METHODS
The authors report a patient with painless acute aortic dissection who presented with sudden onset paraplegia. Ischemic diseases of the spinal cord were suspected as the cause. MRI revealed extensive acute aortic dissection with an intramural hematoma. The patient was treated conservatively by strictly controlling his blood pressure. The treatment was successful, although the motor function of the lower extremities could not be rescued. Although 3% to 5% of patients with acute aortic dissection present with paraplegia as a result of spinal cord infarction, most of these patients experience severe pain prior to presentation.


CONCLUSIONS
Painless acute aortic dissection in which paraplegia is the only presenting sign is very rare. However, aortic diseases, including acute aortic dissection, should always be considered as a differential diagnosis of patients with sudden onset, painless paraplegia.
Inamasu
J
J
Department of Emergency Medicine, Keio University School of Medicine, Tokyo, Japan.
Hori
S
S
Yokoyama
M
M
Funabiki
T
T
Aoki
K
K
Aikawa
N
N
D000208:Acute Disease; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007511:Ischemia / Q000150:complications; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement; D010146:Pain / Q000503:physiopathology; D010264:Paraplegia / Q000209:etiology* / Q000503:physiopathology; D013116:Spinal Cord / Q000098:blood supply