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Chest Pain and Sudden-Onset Paraplegia at the Emergency Department: An Uncommon Presentation

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Feng Han Chiu, Shih Hung Tsai, Cheng Hsuan Ho

Taiwan Department of Emergency Medicine, Tri Service General Hospital, Taipei, Taiwan

Am J Case Rep 2017; 18:728-732

DOI: 10.12659/AJCR.903503

Available online:

Published: 2017-06-29


#903503

BACKGROUND: Coarctation of the aorta is characterized by narrowing of the descending aorta. The narrowing typically is at the isthmus, the segment just distal to the left subclavian artery. Adults with undiagnosed aortic coarctation are asymptomatic or may present with nonspecific hypertension. We present a case that highlights the uncommon complication of aortic coarctation with spinal compression syndrome.
CASE REPORT: A 45-year-old male presented to the emergency department (ED) with acute-onset chest pain; he experienced urinary incontinence and bilateral lower limb weakness during his ED visit. Chest CT showed coarctation of the aorta and MRI of the spine showed an epidural nodular lesion. He received emergency aortic stent placement surgery, followed by successful hematoma removal and was discharged with residual lower-extremity paraplegia.
CONCLUSIONS: Chest pain with lower limb paraplegia presentation should consider aortic coarctation complicated with spinal hemorrhage as a possible cause.

Keywords: Aortic Coarctation, Chest Pain, Hematoma, Epidural, Spinal



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