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Author Tsai, Yi-Da ♦ Hsu, Chin-Wang ♦ Hsu, Chia-Ching ♦ Liao, Wen-I ♦ Chen, Sy-Jou
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Elsevier
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Natural sciences & mathematics ♦ Life sciences; biology ♦ Natural history of organisms ♦ Technology ♦ Medicine & health ♦ Diseases ♦ Surgery & related medical specialties ♦ Manufacture for specific uses ♦ Precision instruments & other devices
Subject Domain (in MeSH) Eukaryota ♦ Organisms ♦ Nervous System Diseases ♦ Cardiovascular Diseases ♦ Pathological Conditions, Signs and Symptoms ♦ Diseases ♦ Diagnosis ♦ Surgical Procedures, Operative ♦ Analytical, Diagnostic and Therapeutic Techniques and Equipment ♦ Persons ♦ Persons
Subject Keyword Discipline Emergency ♦ Discipline Medicine ♦ Aortic Coarctation ♦ Complications ♦ Hematoma, Epidural, Spinal ♦ Paraplegia ♦ Etiology ♦ Diagnosis ♦ Surgery ♦ Blood Vessel Prosthesis Implantation ♦ Diagnosis, Differential ♦ Diagnostic Imaging ♦ Endovascular Procedures ♦ Humans ♦ Male ♦ Young Adult ♦ Case Reports ♦ Journal Article
Abstract Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease.
Description Country affiliation: Taiwan
Author Affiliation: Tsai YD ( Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.); Hsu CW ( Department of Emergency Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan); Hsu CC ( Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.); Liao WI ( Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.); Chen SJ ( Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: syjou.chen@gmail.com.)
ISSN 07356757
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article ♦ Case study
Publisher Date 2016-03-01
Publisher Place United States
e-ISSN 15328171
Journal The American Journal of Emergency Medicine
Volume Number 34
Issue Number 3


Source: WHO-Global Index Medicus