Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Spinal Cord Ser Cases. 2020 Jul 6;6(1):57. doi: 10.1038/s41394-020-0306-5.
Intramural haematoma (IMH) describes the presence of blood within the aortic wall, and is associated with a significant morbidity and mortality. Early diagnosis is essential for institution of medical, and sometimes surgical, management. Neurological complications have rarely been described during the initial presentation of IMH, or other forms of acute aortic syndrome.
We describe a 56-year-old man who presented with sudden onset chest pain and left leg weakness and numbness, and the loss of right leg pain and temperature sensation. CT Angiography showed a Type A intramural haematoma extending from the ascending to the infra-renal aorta. He was managed successfully with cerebrospinal fluid drainage and thoracic endografting to cover the intimal entry lesion. His neurological symptoms improved and he remained well at 3 years with minor residual neurological deficits.
Spinal cord infarction is a rare but documented complication of acute aortic syndrome; Brown-Séquard syndrome typically results from a traumatic injury. To the best of our knowledge, this is the first report of IMH presenting with Brown-Séquard syndrome. This case highlights the need to consider acute aortic syndromes in a patient presenting with chest pain and acute neurological symptoms.
壁内血肿（IMH）描述的是血液存在于主动脉壁内，与较高的发病率和死亡率相关。早期诊断对于实施医学治疗，有时甚至是手术治疗至关重要。在 IMH 或其他类型的急性主动脉综合征的初始表现中，很少有神经并发症的描述。
我们描述了一位 56 岁的男性，他突发胸痛、左腿无力和麻木，右腿疼痛和温度感觉丧失。CT 血管造影显示 A 型壁内血肿从升主动脉延伸至肾下主动脉。他通过脑脊液引流和胸主动脉内覆膜支架植入术成功治疗，覆盖内膜入口病变。他的神经症状改善，3 年后情况良好，仅有轻微的残留神经功能缺损。
脊髓梗死是急性主动脉综合征的罕见但有记录的并发症；Brown-Séquard 综合征通常由创伤性损伤引起。据我们所知，这是首例 IMH 表现为 Brown-Séquard 综合征的报告。该病例强调了在胸痛和急性神经症状患者中需要考虑急性主动脉综合征。
