Sudden Onset of Paraplegia: A Rare Presentation of a Ruptured Abdominal Aortic Aneurysm

Abdominal aortic aneurysms represent an asymptomatic disease that is characterized by the localized pathological dilatation of the infrarenal aorta. Abdominal aortic aneurysms are generally diagnosed incidentally and treated surgically. However, underdiagnosis and lack of high-risk population surveillance contributes to high rates of complications and mortality due to the ultimate rupture of abdominal aortic aneurysms. When symptomatic, abdominal aortic aneurysm rupture usually presents with abdominal or back pain, abdominal pulsatile mass and hemodynamic instability. Neurologic presentations are usually rare and remain poorly characterized. In this report, we present a case of ruptured abdominal aortic aneurysm presenting as acute onset of paraplegia followed by syncope in a 74-year-old male. Typical abdominal aortic aneurysm symptoms were not observed, and surgical treatment was attempted following diagnosis. The patient passed away after exhibiting a sudden onset of hypotension followed by asystole. That being said, clinical and physical findings indicate that neurological complications, and not classic symptoms, could indicate abdominal aortic aneurysm rupture. Spinal cord ischemia due to inadequate blood supply is a possible cause of acute and sudden paraplegia. Adequate monitoring and preventative measures should thus be adopted in order to prevent shearing, occlusion and/or thrombosis of the artery of Adamkiewicz. Moreover, diminished femoral pulses should be considered as potentially reflective of aortic aneurysms or dissection in routine clinical practice.

Headings: Abdominal aortic aneurysms; Cardiovascular disease; Case report; Paraplegia