(429) Attack on Aorta: Vascular Myelopathy Caused by Spinal Cord Infarction Secondary to Aortic Occlusion

Introduction: Vascular myelopathies can present from a spectrum of causes, with spinal cord infarction being a particularly rare cause. We present a case of a 75-year-old female who presented with acute vascular myelopathy from spinal cord infarction secondary to occlusion of the descending aorta.

Description: A 75-year-old female with a history of hypertension, non-insulin-dependent diabetes mellitus, and congestive heart failure presented to the emergency department with acute onset of bilateral leg weakness. The patient had no known history of malignancy, hypercoagulable disorders or recent surgeries.
On presentation, she was hemodynamically stable but displayed significant bilateral lower extremity weakness. Neurological examination revealed 1/5 strength in both lower extremities, with preserved sensation. Deep tendon reflexes were absent in the lower extremities.
Initial laboratory workup was unremarkable. MRI of the spine revealed a T2 hyperintense lesion in the thoracic spinal cord consistent with acute infarction. Subsequent CT angiography demonstrated occlusion of the descending aorta.
The patient was admitted to the ICU and underwent emergent surgical thrombectomy. Despite these interventions, the patient developed respiratory failure requiring mechanical ventilation and eventually succumbed to multi-organ failure.

Discussion: Spinal cord infarction, while rare, presents a significant challenge in the management of vascular myelopathy. In this case, the presentation is particularly rare as most cases are post-procedural especially after thoracic aneurysm repairs.
Diagnosis of spinal cord infarction relies heavily on clinical presentation and imaging studies where MRI is the gold standard for diagnosis. In cases of large vessel occlusion, as seen in our patient, CT angiography can provide valuable information about the extent and location of the occlusion.
Management of spinal cord infarction is complex and often requires a multidisciplinary approach. Initial treatment focuses on maintaining adequate spinal cord perfusion through blood pressure management and anticoagulation. In cases of large vessel occlusion, surgical intervention may be necessary. However, despite prompt recognition and aggressive management, outcomes can be poor, as demonstrated in this case.