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Título

Case Report: Medullary vascular accident due to dissection of the descending branch of the abdominal aorta artery Holy House of Mercy of Santos

RESUMO

Case presentation: A 65 years- old, man, previously diabetic and hypertensive. Admitted to the intensive care unit, with sudden back pain, associated with weakness and paresthesia of the lower limbs. During hospitalization, it evolves with urinary retention, paraplegia and lower limb anesthesia. On admission, an echocardiogram was performed in atrial fibrillation rhythm with diffuse hypokinesia. Magnetic resonance imaging of the skull with areas of restriction to diffusion in the occipital, periventricular and corona radiate regions and of the thoracic spine with signal alteration in the anterior and central situation of the spinal cord, in the T4-T7 region, which correspond to spinal infarction. To proceed with the investigation, a chest angiotomography was requested, which showed thoracoabdominal aortic dissection (type IIIB), with thrombus in the descending aorta and bilateral pericardial and pleural effusion. After the examination findings, the patient was transferred to a referral hospital and surgical correction of the dissection. Discussion: Aortic artery dissection is the rupture of the aortic intima that allows blood to penetrate the aortic wall and promote the discontinuity of vascular layers. The event may be secondary to the presence of an aortic aneurysm, characterized by irreversible dilation of the vessel wall, whose predisposing factors are smoking, hypertension, and atherosclerosis, congenital, genetic and infectious diseases. When dissection occurs, there is a risk of complications, with ischemic phenomena being observed upstream and downstream of the initial orifice, such as spinal cord ischemia, a rare complication with significant neurological symptoms and a high rick of sequel. Objective: To report a case of medullary vascular event secondary to abdominal aortic dissection, as a differential diagnosis of acute flaccid paralysis using data from medical records. Final remarks: The case in question raises the discussion about a rare type of complication resulting from abdominal aortic dissection, spinal ischemia, which must be remembered and investigated in cases of acute flaccid paralysis, aiming at early diagnosis and treatment making it possible to reduce neurological sequel.