title: Reversible spinal cord ischemia as a complication of acute aortic intramural hematoma.
abstract: Aortic intramural hematoma is a variant of acute aortic dissection characterized by localized hemorrhage into the aortic media causing a separation of the intimal and adventitial layers of the aorta. Malperfusion represents an unusual presenting sign of acute intramural hematoma. Herein, we describe the case of a patient with an acute Type A IMH who developed reversible ischemic spinal cord syndrome after presenting with paraplegia as a consequence of malperfusion. A decision was made to delay operative repair and, instead, emergently apply medical interventions to increase spinal cord perfusion pressure. Medical treatment was effective for the treatment of spinal cord ischemia and operative repair of the intramural hematoma was accomplished after complete recovery of neurologic function. This is the third case ever reported of an intramural hematoma presenting in the form of spinal cord ischemia.
authors.affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA, USA ullery@stanford.edu.
authors.forename: Brant W
authors.initials: BW
authors.lastname: Ullery
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Reilly D
authors.initials: RD
authors.lastname: Hobbs
authors.affiliation: Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
mesh_terms: D000208:Acute Disease; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D003097:Collateral Circulation; D005260:Female; D006406:Hematoma / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology; D012039:Regional Blood Flow; D020760:Spinal Cord Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Aortic intramural hematoma; malperfusion; spinal cord ischemia