Acute paraplegia: A presenting manifestation of aortic dissection

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      Two patients who presented with acute paralysis of the lower extremities as an initial manifestation of aortic dissection are described. The first patient had transient chest pain followed by flaccid paralysis of her lower extremities and severe back pain. In the second patient, sudden paralysis of both legs developed without pain of any sort. The paraplegia completely resolved in a few minutes; however, chest and back pain later ensued. Both patients had a proximal (type I or A) aortic dissection. The first patient's entrance tear in the aortic intima was just above the aortic valve with antegrade propagation, whereas in the second patient, the entrance tear was at the aortic isthmus, with both antegrade and retrograde dissection. Acute cardiac tamponade resulted in sudden deterioration and death in both patients, before any therapeutic intervention could be entertained.
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        • Slater EE
        • DeSanctis RW
        The clinical recognition of dissecting aortic aneurysm.
        Am J Med. 1976; 600: 625-633
        • Hirst AE
        • Johns VJ
        • Kime SW
        Dissecting aneurysms of the aorta: a review of 505 cases.
        Medicine (Baltimore). 1958; 37: 217-279
        • Gore I
        Blood and lymphatic vessels.
        in: Anderson WAD Pathology. 6th ed. C.V. Mosby Company, St. Louis1971: 751-754
        • Grubb BP
        • Sirio C
        • Zelis R
        Intravenous labetalol in acute aortic dissection.
        JAMA. 1987; 258: 78-79
        • Hillis LD
        • Ormand JE
        • Willerson JT
        Dissecting aortic aneurysms.
        in: 3rd ed. Manual of clinical problems in cardiology. Little, Brown and Company, Boston1980: 262-265
        • Roberts WC
        Aortic dissection: anatomy, consequences, and causes.
        Am Heart J. 1980; 99: 195-214
        • Wheat MW
        Acute dissecting aneurysms of the aorta: diagnosis and treatment—1979.
        Am Heart J. 1980; 99: 373-387
        • DeBakey ME
        • McCollum CH
        • Crawford ES
        • et al.
        Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred and twenty-seven patients treated surgically.
        Surgery. 1982; 92: 1118-1134
        • Weisman AD
        • Adams RD
        The neurological complications of dissecting aortic aneurysm.
        Brain. 1944; 67: 69-92
        • Prendes JL
        Neurovascular syndromes of aortic dissection.
        Am Fam Physician. 1981; 23: 175-179
        • Scott RW
        • Sancetta SM
        Dissecting aneurysm off the aorta with hemorrhagic infarction of the spinal cord and complete paraplegia.
        Am Heart J. 1949; 38: 747-756
        • McCloy RM
        • Spittell Jr, JA
        • McGoon DC
        The prognosis of aortic dissection.
        Circulation. 1965; 31: 665-669
        • Reul GJ
        • Cooley DA
        • Hallman GL
        • et al.
        Dissecting aneurysm of the descending aorta: improved surgical results in ninety-one patients.
        Arch Surg. 1975; 110: 632-643
        • Crawford ES
        • Rubia PA
        Reappraisal of adjuncts to avoid ischemia in the treatment of aneurysms of the descending thoracic aorta.
        J Thorac Cardiovasc Surg. 1973; 66: 693-704
        • Henson RA
        • Parsons M
        Ischemic lesions of the spinal cord: an illustrated review.
        Q J Med. 1967; 36: 205-222
        • Thompson GB
        Dissecting aortic aneurysm with infarction of the spinal cord.
        Brain. 1956; 79: 111-118
        • Waltimo O
        • Karli P
        Aortic dissection and paraparesis.
        Eur Neurol. 1980; 19: 254-257
        • Turnbull IM
        Blood supply of the spinal cord.
        in: 3rd ed. Handbook of clinical neurology. vol 12. North Holland, Amsterdam1972: 478-491 (Vascular diseases of the nervous system)
        • Greenwood WR
        • Robinson MD
        Painless dissection of the thoracic aorta.
        Am J Emerg Med. 1986; 4: 330-333
        • Siekert RG
        Clinical aspects of vascular disease of the spinal cord.
        in: Toole JF Moossy J Janeway R Cerebral vascular diseases: seventh conference. Grune & Stratton, New York1971: 25-32
        • Howell JM
        • McFarling DA
        • Chisholmm CD
        Ischemic injury to the spinal cord as a cause of transient paraplegia.
        Am J Emerg Med. 1987; 5: 217-219
        • Gilles FH
        • Nag D
        Vulnerability of human spinal cord in transient cardiac arrest.
        Neurology. 1971; 21: 833-837
        • Moossy J
        Vascular diseases of the spinal cord.
        in: 3rd ed. Clinical neurology. vol 3. Harper and Row, Hagerstown1983
        • Kincaid JC
        • Dyken ML
        Myelitis and myelopathy.
        in: 3rd ed. Clinical neurology. vol 3. Harper and Row, Hagerstown1983
        • Ross RT
        Spinal cord infarction in disease and surgery of the aorta.
        Can J Neurol Sci. 1985; 12: 289-295
        • Harris RE
        • Reimer KA
        • Crain BJ
        • et al.
        Spinal cord infarction following intraaortic balloon support.
        Ann Thorac Surg. 1986; 42: 206-207
        • Archer AG
        • Choyke PL
        • Zeman RK
        • et al.
        Aortic dissection following coronary artery bypass surgery: diagnosis by CT.
        Cardiovasc Intervent Radiol. 1986; 9: 142-145
        • Griffith GL
        • Todd EP
        Acute aortic dissection.
        South Med J. 1985; 78: 1487-1493
        • Miller DC
        Acute dissection of the aorta: continuing need for earlier diagnosis and treatment.
        Mod Concep Cardiovasc Dis. 1985; 54: 51-55
        • Cooke JP
        • Safford RE
        Progress in the diagnosis and management of aortic dissection.
        Mayo Clin Proc. 1986; 61: 147-153