title: Myelopathy in adult aortic coarctation: Causes and caveats of an atypical presentation.
abstract: A 57-year-old female presenting with acute-onset paraplegia was referred for magnetic resonance imaging (MRI) of cervico-dorsal spine. On MRI, multiple tortuous dilated vessels were noted in the epidural space with long segment cord compression and imaging features of compressive myelopathy. Associated small acute cervico-dorsal epidural hematoma was also noted in the same region. Computed tomography (CT) angiography was performed subsequently which revealed post-ductal coarctation of aorta with multiple arterial collaterals in the chest wall and spinal canal. An extensive review of English language literature pertaining to the clinical presentations of adult aortic coarctation revealed only few reports of acute compressive myelopathy due to spinal epidural collateral vessels. Further, presentation at such a late age has not been reported before. In the present case, apart from a hypertrophied anterior spinal artery and perispinal collaterals, an anterior epidural hematoma was an additional important factor in the causation of myelopathy.
authors.affiliation: Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Chandan
authors.initials: C
authors.lastname: Mourya
authors.affiliation: Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Bansal
authors.affiliation: Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Ram C
authors.initials: RC
authors.lastname: Shukla
authors.affiliation: Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Srivastava
keywords: Coarctation; collaterals; compressive myelopathy; epidural hematoma