title: Acute aortic dissection presenting as painful paraplegia.
abstract: Aortic dissection is a rare potentially life threatening condition. Neurological complications such as paraplegia as presenting manifestation of aortic dissection are exceedingly rare. We describe a 60-year-old man who presented with acute onset paraplegia with bladder involvement, constricting pain in the lower abdomen, bradycardia and succumbed rapidly within 14h of onset of symptoms. Autopsy revealed an unexpected cause of paraplegia with extensive aortic dissection extending from origin to iliac bifurcation (DeBakey type I). The aorta showed extensive atherosclerosis causing medial destruction and dissection. The spinal cord in the vulnerable watershed zone of T12-L1 downwards revealed ischemic softening. No infarcts were seen in other organs as he succumbed rapidly to cardiac tamponade. Acute aortic dissection presenting as paraplegia though rare, should be considered in patients presenting with sudden onset paraplegia with associated severe pain and absent pulses. Prompt diagnosis and timely intervention may help save life and limb.
authors.affiliation: Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Nandeesh
authors.forename: A
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Vani
authors.initials: V
authors.lastname: Santosh
authors.forename: T C
authors.initials: TC
authors.lastname: Yasha
authors.forename: S K
authors.initials: SK
authors.lastname: Shankar
mesh_terms: D015746:Abdominal Pain / Q000209:etiology* / Q000473:pathology; D000784:Aortic Dissection / Q000175:diagnosis* / Q000473:pathology; D001011:Aorta / Q000473:pathology; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000473:pathology; D050197:Atherosclerosis / Q000473:pathology; D002305:Cardiac Tamponade / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D010264:Paraplegia / Q000209:etiology* / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology