Endovascular treatment of an acute ascending aortic intramural hematoma

Neurological presentation of acute aortic syndrome: Type A intramural haematoma presenting as ischaemic hemisection of the spinal cord

INTRODUCTION

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.

CASE PRESENTATION

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.

DISCUSSION

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.

Endovascular Stent Graft Repair of Localized Acute Aortic Intramural Hematoma: A Case Report and Literature Review

Aortic intramural hematoma (IMH) is a variant of acute aortic syndrome, which can be life-threatening. Ascending aorta IMHs, particularly accompanied by penetrating aortic ulcer (PAU), can cause dissection, rupture, and cardiac tamponade. Therefore, early surgical treatment is recommended for IMHs of the ascending aorta. Herein, we present the case of a 60-year-old male patient who was on warfarin sodium treatment and in whom an IMH localized to the arcus aorta was detected incidentally via computed tomography, with the suspicion of pulmonary embolism, and an endovascular stent graft was inserted into the arcus aorta. This case highlights the importance of following ulcerated aortic plaques and suggests that IMH can be successfully treated with endovascular stent grafting.