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Jurado PR, Aragón FH, González VAM, Silva JAL, Gutiérrez EAP, Ortiz NKP, Vázquez ACQ, Venzor LFT, Aponte EEG, Madrid AA, Nafarrate EB. Spontaneous Recovery of Paraplegia in a Polytrauma Patient following Spinal Cord Ischemia due to Type B Traumatic Aortic Dissection. Case Rep Orthop 2023; 2023:8918724. [PMID: 37600152 PMCID: PMC10438978 DOI: 10.1155/2023/8918724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/07/2023] [Accepted: 08/05/2023] [Indexed: 08/22/2023] Open
Abstract
Aortic dissection is a life-threatening acute condition characterized by the separation of the aortic wall's layers. It is caused by a tear in the internal vascular wall (intimal layer and middle layer), which results in bleeding between the layers and causes abrupt and excruciating pain. The appropriate consideration must be given to the condition's dynamic nature, and variations in clinical presentation, without neglecting the urgency for intervention. In this case study, a 65-year-old male engaged in a car accident is admitted to urgent care with a traumatic aortic dissection diagnosis that included the aortic arch, a segmental exposed fracture of 1/3 distal of the right femur AO 32C3k, and an intertrochanteric fracture AO 31A1.3. The patient developed transient paraplegia as the initial manifestation of acute aortic dissection, which represents a high mortality and morbidity entity without adequate and prompt treatment, and prompt diagnosis and management were critical. A patient with severe thoracic and abdominal trauma caused by high-energy injury should be properly evaluated for the possibility of traumatic aortic dissection. The endovascular aortic repair was performed, resulting in a positive clinical evolution due to the important participation of the multidisciplinary trauma team involved in patient management and prompted decision-making.
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Affiliation(s)
- Pedro Ramos Jurado
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
| | - Fernando Hernández Aragón
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
| | - Víctor Aaron Miranda González
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
| | - Jesús Antonio Loya Silva
- Department of Angiology and Vascular Surgery Hospital Ángeles Chihuahua (CIMA Hospital), C. Haciendas del Valle 7120-Interior 21, Haciendas del Valle III, Chihuahua, 31217 Chih, Mexico
| | - Edgar Azael Pérez Gutiérrez
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
| | | | | | | | - Eduardo Enrique Gámez Aponte
- Universidad de Monterrey (UDEM), Ignacio Morones Prieto Avenue 4500 W, San Pedro Garza Garcia, Nuevo Leon 66238, Mexico
| | - Arturo Aguirre Madrid
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
| | - Edmundo Berumen Nafarrate
- Department of Orthopedic Surgery, Christus Muguerza del Parque Hospital, De la Llave Street No. 1419, Office 9, Col. Centro, Chihuahua 31000, Mexico
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Gambirasio BG, Amaral RM, Yoshinaga Tonholo Silva T, Costa DMC, Rezende Filho FM, Caldeira Brant PHR, Escorcio-Bezerra ML, Barsottini OGP, Pedroso JL. Ischaemic lumbosacral plexopathy following aortic dissection. Pract Neurol 2023; 23:67-70. [PMID: 35995555 DOI: 10.1136/pn-2022-003462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 02/02/2023]
Abstract
A 57-year-old man was diagnosed with acute myocardial infarction and Stanford type A aortic dissection that had spread to the common iliac arteries. He underwent a Bentall procedure for vascular repair. Immediately after surgery, he developed numbness and severe weakness in his left leg. On examination, he had hypotonia, absent deep tendon reflexes, weakness in the left leg (Medical Research Council (MRC) scale for muscle strength - 0/5 distal, 3/5 proximal) and reduced sensation in the left leg. Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus. MR scan of the lumbar plexus showed diffuse muscle oedema involving the left gluteus maximus. We diagnosed ischaemic lumbosacral plexopathy secondary to extensive aorta dissection and internal iliac artery occlusion. We discuss the clinical features of ischaemic plexopathy and the diagnostic approach and review the vascular anatomy of the lumbosacral plexus.
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Affiliation(s)
| | - Rodrigo Matos Amaral
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | - Orlando G P Barsottini
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
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Álvarez M, Lucente G, Martínez L, Almendrote M, Ramos A, Broto J, Arbex A, Coll J, Sancho J, Martinez A. Paraplegia Following Type B Acute Aortic Dissection Can Spare the Spinal Cord. Ann Vasc Surg 2020; 70:569.e1-569.e4. [PMID: 32927034 DOI: 10.1016/j.avsg.2020.08.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/15/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
Ischemic lumbosacral plexopathy secondary to an acute aortic dissection is a rare condition that is usually unilateral and frequently accompanied by a simultaneous spinal cord infarction. The functional prognosis relies on the severity of the nervous system involvement being usually worse when the spinal cord is involved. We present a case of a 46-year-old man who suffered an acute type B aortic dissection presenting as acute paraplegia due to bilateral ischemic lumbosacral plexopathy treated with thoracic endovascular aortic repair. An up-to-date review of the literature on ischemic lumbosacral plexus injury is provided.
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Affiliation(s)
- Marta Álvarez
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Giuseppe Lucente
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain.
| | - Lucia Martínez
- Vascular Surgery Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Miriam Almendrote
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Alba Ramos
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Joaquin Broto
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Andrea Arbex
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Jaume Coll
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Joan Sancho
- Vascular Surgery Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Alicia Martinez
- Neuromuscular and Neuropediatric Disease Group, Neuroscience Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
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