Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage

Yi Da Tsai, Chin Wang Hsu, Chia Ching Hsu, Wen I. Liao, Sy Jou Chen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease.

Original languageEnglish
JournalAmerican Journal of Emergency Medicine
Volume34
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Fingerprint

Spinal Epidural Hematoma
Aortic Coarctation
Paraplegia
Chest Pain
Hemorrhage
Dissection
Lower Extremity
Coronary Vessels
Epidural Space
Lumbosacral Region
Spinal Cord Compression
Ruptured Aneurysm
Bundle-Branch Block
Hypesthesia
Back Pain
Disease Management
Coronary Angiography
Paralysis
Nervous System
Aneurysm

ASJC Scopus subject areas

  • Medicine(all)
  • Emergency Medicine

Cite this

Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage. / Tsai, Yi Da; Hsu, Chin Wang; Hsu, Chia Ching; Liao, Wen I.; Chen, Sy Jou.

In: American Journal of Emergency Medicine, Vol. 34, No. 3, 01.03.2016.

Research output: Contribution to journalArticle

Tsai, Yi Da ; Hsu, Chin Wang ; Hsu, Chia Ching ; Liao, Wen I. ; Chen, Sy Jou. / Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage. In: American Journal of Emergency Medicine. 2016 ; Vol. 34, No. 3.
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