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CASE SNIPPET
Year : 2012  |  Volume : 58  |  Issue : 4  |  Page : 306-307

Acute abdominal aortic occlusion mimicking myeleterosis: A diagnostic challenge


1 Department of Neurology, First Affiliated Hospital, Gannan Medical College, Jiangxi, China
2 Department of Surgery, Affiliated Ganzhou Hospital, Nanchang University, Jiangxi, China
3 Department of Radiology, First Affiliated Hospital, Gannan Medical College, Jiangxi, China

Date of Web Publication4-Jan-2013

Correspondence Address:
Y Huang
Department of Neurology, First Affiliated Hospital, Gannan Medical College, Jiangxi
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.105462

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How to cite this article:
Huang Y, Chen J P, Wang J. Acute abdominal aortic occlusion mimicking myeleterosis: A diagnostic challenge. J Postgrad Med 2012;58:306-7

How to cite this URL:
Huang Y, Chen J P, Wang J. Acute abdominal aortic occlusion mimicking myeleterosis: A diagnostic challenge. J Postgrad Med [serial online] 2012 [cited 2020 Oct 29];58:306-7. Available from: https://www.jpgmonline.com/text.asp?2012/58/4/306/105462


A cute abdominal aortic occlusion is a rare, severe vascular disease characterized by classic six "P's": pain, pallor, pulselessness, paralysis, paresthesia, and poikilothermia [1] and its clinical manifestations are much like myeleterosis. [2] The prognosis is very poor and the mortality is over 30%. [1]

A 60-year-old female was admitted to our hospital 6 days after the acute onset of numbness and weakness of both lower extremities, followed by urinary and fecal incontinence. She had a history of mitral valve stenosis, atrial fibrillation, and hypertension for many years without regular treatment. Physical examination revealed a grade 3/6 diastolic murmur at the apex of the heart. Peripheral pulse examination revealed normal arterial pulsation in the carotid and upper extremities, while both dorsal pedal arterial pulses were weak. Strength of the both lower extremities were 2/5 degree. Deep tendon reflexes were absent in the lower extremities. Loss of all modality of sensation was observed in the distal extremities from the ankle. Pathologic reflexes were negative. The hemoglobin was 12.7 gm%, erythrocyte sedimentation rate 74 mm/h, fibrinogen(FIB) 5.28 g/L, glutamic oxaloacetic transaminase (GOT) 1631 U/L, glutamic pyruvic transaminase (GPT) 595 U/L, creatine kinase (CK) 93860 U/L, CK-MB 1640 U/L, Lactate dehydrogenase(LDH) 2744 U/L, total bilirubin 21.26 μmol/L, alkaline phosphatase 94 U/L, blood urea nitrogen (BUN) 10.96 mmol/L, and creatinine 136 μmol/L. A chest X-ray showed slight cardiomegaly and electrocardiogram revealed atrial fibrilation and premature ventricular contraction. Two-dimensional echocardiography demonstrated moderate mitral stenosis, pericardial effusion, and left atrial appendage thrombus formation. Lumbar puncture and spinemagnetic resonance imaging (MRI) revealed no abnormality. Magnetic resonance angiography revealed occlusion of abdominal aorta just below the renal artery, involving the right iliac artery [Figure 1]. Urgent surgery thus was performed by bilateral femoral embolectomy. Because there was the long delay from presentation to revascularization, the patient died 3 days after operation due to congestive heart failure and renal failure.
Figure 1: MRA showing occlusion of the distal abdominal aorta and left distal renal artery, involving the right iliac artery, and left renal atrophy

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Embolic phenomenon in valvular disease of the heart is common and the emboli generally display a predilection for the central nervous system, but also can affect other organs such as the liver, spleen, kidney, retina, coronary vessels, and distal arterial tree. We initially suspected a myeleterosis because the patient had dyskinesia, sensory disability, sphincter dysfunction, and absence of abdominal pain. But, there were neither characteristics of anterior spinal artery occlusion (conductive beam-dissociated sensory disturbance), nor characteristics of posterior spinal artery occlusion (deep anesthesia and sensory ataxia, pain sensations of warmth and strength saved, and sphincteral function didn't affect), and the lumbar puncture and spinal MRI indicate normal. In this case, vascular examination was not performed until the patient had undergone lumbar puncture and spine MRI to exclude myeleterosis. However, confusion can be minimized by taking a thorough history and performing a thorough vascular and neurological examination in patients who present with weakness of the both lower extremities. Clinical paraplegia should be entertained in the diagnosis of abdominal aortic embolism when the presentation is otherwise not apparent.

 
 :: References Top

1.Surowiec SM, Isiklar H, Sreeram S, Weiss VJ, Lumsden AB. Acute occlusion of the abdominal aorta. Am J Surg1998;176:193-7.  Back to cited text no. 1
[PUBMED]    
2.Shahin Y. Acute embolic occlusion of the distal aorta associated with left ventricularthrombus. Postgrad Med J 2010;86:446.  Back to cited text no. 2
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2004 - Journal of Postgraduate Medicine
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