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

Spinal cord infarction resulting from intramural haematoma of the thoracic aorta

We present the case of a female patient in her 60s with multiple medical comorbidities who presented to the emergency department with sudden-onset tearing chest, back and abdominal pain in the setting of a hypertensive emergency. Initial CT-angiography demonstrated mild-diffuse thickening of thoracic and abdominal aorta without signs of intramural haematoma or dissection. The patient was subsequently admitted and medically managed. In the days following admission, the patient developed a small bowel obstruction and neurological deficits. Repeat imaging demonstrated an intramural haematoma extending from left subclavian artery to the diaphragm resulting in foci of spinal cord infarction. Instances of spinal cord infarction secondary to aortic intramural haematoma are rare, with a minority of cases reported as of 2020. This case report highlights a non-classic patient presentation of an intramural haematoma, shedding light onto possible clinical outcomes, treatment options and important risk factors.

Thoracic ossification of the ligamentum flavum causing Brown-Séquard syndrome: a case report and literature review

Brown-Séquard syndrome (BSS) has many etiologies, including penetrating trauma, extramedullary tumors, and disc herniation. However, thoracic ossification of the ligamentum flavum (OLF) is an extremely rare cause of this syndrome. A 46-year-old woman with motor weakness in her right lower extremity and urinary retention was admitted to our department. Based on the results of physical examination, computed tomography, and magnetic resonance imaging, a diagnosis of BSS with OLF was considered. The patient underwent urgent conservative treatment. BSS is a rare condition characterized by hemisection or hemicompression of the spinal marrow. The herein-described case of incomplete BSS due to OLF responded to conservative treatment. However, the successful nonoperative management of this case is insufficient evidence to consider it as the standard of care. Therefore, emergency laminectomy decompression remains the standard of care for BSS.