Abstract
Background
Occlusive abdominal aortic thrombus is a rare but critical clinical emergency with
life-threatening consequences. Clinical presentation may mimic other diagnoses, resulting
in a delay in the appropriate investigations for this condition. Spinal arterial involvement
is a recognized complication of aortic thrombus and can result in pain, lower limb
weakness, and loss of continence. These symptoms are usually associated with local
spinal compression or stenosis manifesting as cauda equina syndrome (CES): a clinical
finding of disrupted motor and sensory function to the lower extremities and bladder.
Case Report
We present a case of a 60-year-old female patient presenting with back pain, leg weakness,
paresthesia, and urinary incontinence. She was urgently investigated for cauda equina
syndrome via a magnetic resonance imaging scan of the spine, which subsequently demonstrated
a large occlusive abdominal aortic thrombus.
Why Should an Emergency Physician Be Aware of This?
Nontraumatic acute thrombosis of the aorta is a life-threatening condition that may
present with apparent neurological symptoms. In this patient there was both a relevant
history and evolving clinical signs pointing toward a vascular etiology; however,
the clinical findings were confusing and CES evaluation was prioritized. CES remains
a medical emergency requiring urgent investigation and management. However, knowledge
of spinal anatomy including vascular supply may help widen the differential. Physicians
and associate specialists should consider this at clinical assessment and also when
interpreting imaging of the spine. Any delay in diagnosing an aortic thrombosis has
the potential for catastrophic clinical consequences.
Keywords
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Article info
Publication history
Published online: April 10, 2020
Accepted:
March 18,
2020
Received in revised form:
February 22,
2020
Received:
November 9,
2019
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. All rights reserved.
