&lt;I&gt;Transient Paraplegia Caused by Acute Aortic Dissection&lt;/I&gt;

Tanaka, Tokutaro; Uemura, Kenichi; Sugiura, Masayuki; Ohishi, Haruyuki; Tomita, Mamoru; Nagasaki, F; Matsuda, Shigeru; Kobayashi, Ryo; Fukaya, T

doi:10.2176/nmc.30.54

Cited by 15 publications

(15 citation statements)

References 15 publications

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“…Although paraplegia is a well-known manifestation of AAD, reportedly experienced by 2% to 8% of all AAD patients, 3 most of these patients experience severe pain prior to the development of paraplegia. 4 In the case reported here, AAD was detected by MRI, which is considered a vital tool for making a de®nitive diagnosis in patients presenting with sudden onset, painless paraplegia.…”

Section: Introductionmentioning

confidence: 74%

“…Most AAD patients with paraplegia experience severe pain prior to presentation. 4 Only eight such cases have been reported in the literature (Table 1), 3,9 ± 16 and ®ve of the patients had type A dissections and the other three patients had type B. Unlike acute myocardial infarction, in which the incidence of painless infarct is greater in elderly and diabetic patients, 17 few common clinical characteristics can be derived from the constellation of patients with painless AAD.…”

Section: Discussionmentioning

confidence: 99%

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Paraplegia caused by painless acute aortic dissection

et al. 2000

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Objectives: Painless acute aortic dissection in which paraplegia is the only presenting sign is rare, with limited reported cases. Case report: The authors report a patient with painless acute aortic dissection who presented with sudden onset paraplegia. Ischemic diseases of the spinal cord were suspected as the cause. MRI revealed extensive acute aortic dissection with an intramural hematoma. The patient was treated conservatively by strictly controlling his blood pressure. The treatment was successful, although the motor function of the lower extremities could not be rescued. Although 3% to 5% of patients with acute aortic dissection present with paraplegia as a result of spinal cord infarction, most of these patients experience severe pain prior to presentation. Conclusion: Painless acute aortic dissection in which paraplegia is the only presenting sign is very rare. However, aortic diseases, including acute aortic dissection, should always be considered as a dierential diagnosis of patients with sudden onset, painless paraplegia. Spinal Cord (2000) 38, 702 ± 704

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Section: Introductionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Paraplegia caused by painless acute aortic dissection

et al. 2000

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“…In 17-40% of patients with DAs, neurologic symptoms can be manifested 6,10,11,17) . The causes of ischemic neurologic deficits are occlusions of main feeding arteries, such as the carotid, vertebral, and spinal arteries, or vasa nervorum of the peripheral nerves, or hypotension-induced perfusion failures 12) , which can induce ischemic stroke, spinal cord ischemia, ischemic neuropathy, hypoxic encephalopathy, or syncope.…”

Section: Discussionmentioning

confidence: 99%

Painless Dissecting Aneurysm of the Aorta Presenting as Simultaneous Cerebral and Spinal Cord Infarctions

Kwon

Sung

Kim

et al. 2011

J Korean Neurosurg Soc

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and 2-8% 2) of patients with DAs, respectively. If these neurologic manifestations occur without pain, although rare, the possibility of DA can be missed without a high index of suspicion 1,7,13) . We managed a patient with a painless DA in which cerebral hemodynamic infarction and thoracic spinal cord ischemia occurred concurrently. Herein, we have focused on the important diagnostic features and therapeutic considerations of DA with a review of the literature. CASE REPORTA 51-year-old man was referred for further evaluation and treatment of paraplegia and right arm monoparesis. At the referral clinic, he was hypotensive (80/50 mmHg) and diagnosed as septic shock. In the emergency room, the blood pressure was 110/80 mmHg and the pulse was 88 beats/min. The duration of hypotension was less than 24 hours. On physical examination, there were no abnormal findings and he denied any pain in the chest, neck, back, or abdomen. On neurologic examination, the patient was somnolent, but could communicate with the examiners. There was right upper extremity weakness (motor grade II/V) and lower extremity weakness bilaterally (motor grade I/ V). Below the T6 dermatome, anesthesia to pain and hypesthesia to light touch was noted. Below the T11 dermatome, total anesthesia were demonstrated to all types of stimuli. Perianal sensation, and voluntary and involuntary anal sphincter tone could not be elicited. On a plain chest posteroanterior (PA) ra- INTRODUCTIONAn acute dissecting aneurysm (DA) of the aorta is a rare vascular event with an incidence of 5-30 cases per million people per year 12) . A DA is an uncommon, but potentially catastrophic pathologic change with an extremely high mortality and morbidity. The classic, well-known, typical symptom of DA is severe chest or abdominal pain radiating to the back. This abrupt, lancinating pain can easily make physicians alert and cautious. However, it is important that not all DAs elicit typical pain and the correct diagnosis followed by urgent management cannot always be made. In one report, a DA was missed in 38% of patients on presentation, with 28% of cases diagnosed during autopsy 16) . The frequency of pain-free DAs ranges between 5% and 15% 7,9,13,16) . Such patients with DAs demonstrate signs and symptoms dependent on the involved arterial branches from the ascending to the descending aorta.The neurologic symptoms associated with DA are often dramatic and may completely dominate the clinical features. The frequency of neurologic involvement, including transient deficits, varies between 17% and 40% 1,7,9,13) . Cerebral ischemia and Department of Neurosurgery, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, KoreaAuthors report a case of a painless acute dissecting aneurysm of the descending aorta in a patient who presented with unexplained hypotension followed by simultaneous paraplegia and right arm monoparesis. To our knowledge, case like this has not been reported previously. Magnetic resonance imaging of the brain and spine revealed h...

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“…Uma revisão da literatura permitiu-nos encontrar algumas referências sobre paraplegia, conseqüente à DAA, a maioria sob forma de relato de caso, sendo que nenhum autor reuniu mais do que três pacientes em suas casuísticas [11][12][13][14][15][16][17][18] . A paraplegia é atribuída a isquemia ou infarto da medula espinhal devido a interrupção do fluxo sangüíneo para as artérias espinhais anteriores e posteriores.…”

Section: Discussionunclassified

“…O infarto, tipicamente, ocorre na região compreendida entre a artéria de Adamkiewics (ramo da aorta abdominal que irriga a medula espinhal) e a artéria espinhal anterior (ramo das artérias vertebrais). Quase a metade dos pacientes faleceu na fase aguda da DAA, em alguns casos em decorrência de tamponamento cardíaco [11][12][13][14][15][16][17][18] . Alguns apresentaram reversão da paraplegia, ainda na fase aguda da DAA 11,12,14,16 e, em outros, a paraplegia não foi acompanhada de nenhum tipo de dor 12,16 .…”

Section: Discussionunclassified

Paraplegia aguda. Uma complicação rara da dissecção aórtica

Lacerda¹,

Andréa²,

Neto³

et al. 1998

Arq. Bras. Cardiol.

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Relato de CasoA dissecção aórtica aguda (DAA) é uma emergência médica que exige pronto diagnóstico e terapêutica agressiva, já que as complicações a ela associadas são múltiplas, graves e freqüentemente fatais 1 . Quando o paciente apresenta-se com dor precordial ou tóraco-abdominal de início abrupto, hipertensão grave e eletrocardiograma (ECG) não sugestivo de infarto agudo do miocárdio (IAM), a hipótese diagnóstica geralmente é levantada, sobretudo se a radiografia do tórax mostrar alargamento do mediastino 2,3 , devendo-se prosseguir com outros métodos de imagem de comprovada eficácia diagnóstica 4-6 , conforme a disponibilidade dos recursos locais. A DAA, entretanto, pode se manifestar de outras formas, e seu diagnóstico ficar mascarado, devendo-se estar muito atento para alguma de suas apresentações menos comuns: insuficiência aórtica aguda, levando à insuficiência cardíaca ou choque, tamponamento cardíaco, síncope ou choque não esclarecido, acidente vascular encefálico (AVE), isquemia aguda de membros inferiores e IAM 1,[7][8][9] . Relatamos um caso que apresenta complicação rara e pouco conhecida da DAA, a paraplegia aguda. Relato do CasoMulher de 67 anos, branca, apresentou quadro de sín-cope, sendo levada por familiares a um Pronto-Socorro, onde foi atendida com quadro de choque e transferida no dia seguinte para a Unidade de Cardiologia Intensiva do Hospital Geral de Bonsucesso. Encontrava-se torporosa, dispnéica, extremidades levemente cianóticas e frias, taquicárdica (130bpm), pressão arterial (PA) sistólica 60mmHg. Medicada com oxigênio por cânula nasal, solução fisiológica, dopamina e dobutamina, apresentou melhora hemodinâmica significativa, possibilitando a suspensão das drogas vasoativas após 24h, mantendo PA em torno de 110/70mmHg em ambos os membros superiores. Obteve-se informação de que levava vida ativa como dona de casa e de que, dois anos antes, fora tratada de um câncer uterino, através de radioterapia, sem que tivesse sido submetida a histerectomia. Não era hipertensa e desconhecia ser portadora de doença cardíaca.

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<I>Transient Paraplegia Caused by Acute Aortic Dissection</I>

Cited by 15 publications

References 15 publications

Paraplegia caused by painless acute aortic dissection

Paraplegia caused by painless acute aortic dissection

Painless Dissecting Aneurysm of the Aorta Presenting as Simultaneous Cerebral and Spinal Cord Infarctions

Paraplegia aguda. Uma complicação rara da dissecção aórtica

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