Aortic Dissection Presenting Primarily as Acute Spinal Cord Damage: A Case Report and Literature Review

Abstract

Acute aortic dissection is a rare, life-threatening condition. Clinical manifestations generally include the acute onset of severe chest or back pain. Aortic dissection presenting with signs and symptoms of acute spinal cord damage is the most severe complication and is particularly rare. This paper reports a case of aortic dissection in a 50-year-old man with a 10-year history of hypertension manifesting as acute spinal cord damage (bilateral lower extremity weakness and loss of all types of sensation), acute skeletal muscle ischaemic necrosis with increased levels of creatine kinase, and acute kidney failure with increased levels of serum creatinine and decreased glomerular filtration rate. The patient refused surgical treatment. His clinical condition progressively worsened and he died 3 days later. This case indicates the importance of considering aortic dissection in patients presenting with acute spinal cord damage, acute skeletal muscle necrosis or acute kidney failure, which may allow early diagnosis and reduce the mortality rate.

A Case of Acute Paraplegia Due to Aortic Dissection in Marfan Syndrome

“…The mortality rate will increase if there is delay in diagnosis. [11] General physical and all systemic examination are mandatory even in emergency settings, which may give important clues for the accurate and complete diagnosis. Occurrence of pressure sore in absent sacral sensation is common and higher level of care must be executed.…”

Acute Aortic Dissection and Medullary Ischemia in a Patient with Marfan syndrome

“…The intervention should be immediate, with the objective being avoiding vessel rupture and consequent death by cardiac tamponade. [5] On the other hand, in type B dissections, the evolution is much more favorable with clinical treatment, with a mortality rate of 10% in 30 days, while in surgically treated patients mortality is 31%. [8] The endovascular approach is usually not indicated for patients with MS due to poor aortic tissue quality and continuous dilatation, even after technically successful procedures.…”

“…Although rare, spinal cord injuries are associated with a considerably increased morbidity and mortality rates, as well as poor prognosis. [5] Spinal cord ischemia may develop with paraplegia, resulting in loss of function and control of the bowel and bladder; spinal cord ischemia is one of the major complications of open or endovascular thoracic surgery. It is caused by an aortic repair or endovascular stent of relevant arteries that irrigate the spinal cord associated with other risk factors, such as hypotension and anemia.…”

“…Simultaneous mesenteric ischemia is responsible for severe abdominal pain and acute paraplegia. [5] Placement of a graft or stent can lead to a reduction in spinal blood flow and can cause direct cytotoxic action within a short period of time. In addition, edema develops, accompanied by the development of the spinal cord compartment syndrome and increased pressure due to the action of these cytotoxic agents.…”

“…The cardiovascular involvement of MS is characterized mainly by aortic root and arch changes, resulting in increased susceptibility for the development of aneurysms. [3] Progressive dilatation of the aortic root, potentially leading to dissection and rupture, is the main cause of death in patients with MS. [4,5] In the present study, we describe a rare case of medullary ischemia secondary to abdominal aortic dissection (Stanford type B) 3 years after dissection of the ascending aorta (type A) in a young patient with MS.…”