Nandeesh B N, Mahadevan A, Santosh Vani, Yasha T C, Shankar S K
Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore, India.
Clin Neurol Neurosurg. 2007 Jul;109(6):531-4. doi: 10.1016/j.clineuro.2007.03.010. Epub 2007 May 1.
Aortic dissection is a rare potentially life threatening condition. Neurological complications such as paraplegia as presenting manifestation of aortic dissection are exceedingly rare. We describe a 60-year-old man who presented with acute onset paraplegia with bladder involvement, constricting pain in the lower abdomen, bradycardia and succumbed rapidly within 14h of onset of symptoms. Autopsy revealed an unexpected cause of paraplegia with extensive aortic dissection extending from origin to iliac bifurcation (DeBakey type I). The aorta showed extensive atherosclerosis causing medial destruction and dissection. The spinal cord in the vulnerable watershed zone of T12-L1 downwards revealed ischemic softening. No infarcts were seen in other organs as he succumbed rapidly to cardiac tamponade. Acute aortic dissection presenting as paraplegia though rare, should be considered in patients presenting with sudden onset paraplegia with associated severe pain and absent pulses. Prompt diagnosis and timely intervention may help save life and limb.
主动脉夹层是一种罕见的、潜在危及生命的疾病。诸如截瘫作为主动脉夹层的表现形式的神经并发症极其罕见。我们描述了一名60岁男性，他出现急性截瘫伴膀胱受累、下腹部绞痛、心动过缓，并在症状发作后14小时内迅速死亡。尸检发现截瘫的意外原因是广泛的主动脉夹层，从起源延伸至髂总动脉分叉处（DeBakey I型）。主动脉显示广泛的动脉粥样硬化，导致中膜破坏和夹层形成。T12-L1以下易损分水岭区的脊髓显示缺血性软化。由于他迅速死于心脏压塞，其他器官未见梗死。急性主动脉夹层以截瘫形式出现虽然罕见，但对于突然出现截瘫并伴有严重疼痛和脉搏消失的患者应予以考虑。及时诊断和适时干预可能有助于挽救生命和肢体。
