Aortic thrombosis presenting with low back pain and paraplegia: a medical alert

Abstract

Context:The importance of a thorough neurological examination of the patient should always include research into differential diagnoses such as vascular syndromes, increasingly common in our population. Case report: A 46-year-old man evaluated and screened by the Neurosurgery’s department team, after an initial complaint of sudden onset low back pain and acute weakness in both lower limbs. The patient was healthy before the event. Patient didn’t have pathological history or use of chronic medications, referring only to use sporadic medication for sexual impotence, approximately 6 months ago. Observation revealed pale cold lower limbs, with livedo reticularis. Pulses of the femoral artery were absent bilaterally. Neurological examination revealed complete flaccid paraplegia with neurological level of L1. Below this level loss of pain, light touch and temperature sensation (0/2 in all dermatomes on both extremities), muscle weakness (0/5 in all neurotomes bilaterally), absent tendon and plantar reflexes. Axial tomography of the lumbar spine didn’t reveal vertebral lesions or pressure within the spinal canal. Consultation of the vascular surgeon confirmed absence of blood flow through femoral arteries and emergency angiotomography of the abdominal aorta showed complete occlusion of the descending aorta, upper renal arteries. Patient underwent percutaneous embolectomy treatment, with successful revascularization of lower extremities; unfortunately died about 10 hours after surgery due the development of revascularization syndrome. Conclusions: Acute aortic occlusion is a catastrophic event and can present itself as flaccid paraplegia, leading to misdiagnosis and loss of valuable time for positive outcome. Vascular examination should always be performed on each patient with neurological deficit in lower limbs, especially patients with clinical history of peripheral vascular disease. Immediate start of treatment is imperative to improve survival rates.