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Recovery of neurological function following type B aortic dissection complicated by paraplegia
  1. Ben Li1,
  2. Zeyad Khoshhal1,
  3. Andrew Common2 and
  4. Mohammad Qadura1,3
  1. 1Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Interventional Radiology, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
  3. 3Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Mohammad Qadura; mohammad.qadura{at}utoronto.ca

Abstract

A woman in her 50s presented with uncontrolled hypertension, chest/back pain, paraplegia, right lower limb ischaemia and acute kidney injury. A CT angiogram demonstrated a type B aortic dissection originating distal to the left subclavian artery to bilateral common iliac arteries complicated by occlusion of the right renal artery and right common iliac artery. She was started on intravenous antihypertensive therapy and transferred to our institution for emergent thoracic endovascular aortic repair. Due to bleeding risk from coagulopathy, a spinal drain was not placed immediately post-operatively but instead was inserted after 24 hours while maintaining a mean arterial pressure of 80–100 mm Hg. Postoperatively, her right lower extremity perfusion was re-established, and her renal function recovered following temporary dialysis. At discharge on postoperative day 13, she regained full neurological function.

  • Vascular surgery
  • Acute renal failure
  • Interventional radiology
  • Neurological injury
  • Adult intensive care

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Footnotes

  • Contributors Conceptualisation, BL, ZK, AC and MQ; methodology, BL, ZK, AC and MQ; software, BL and AC; validation, BL, ZK, AC and MQ; formal analysis, BL, ZK and MQ; investigation, BL, ZK and MQ; resources, BL, ZK, AC and MQ; data curation, BL, ZK, AC, MQ; writing—original draft preparation, BL; writing—review and editing, BL, ZK, AC and MQ; visualisation, AC; supervision, MQ; project administration, MQ; funding acquisition, MQ. All authors read and agreed to the published version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.