Chest Pain and Sudden-Onset Paraplegia at the Emergency Department: An Uncommon Presentation

Patient: Male, 45 Final Diagnosis: Acute coarctation with spinal epidural hemorrhage Symptoms: Chest pain with bilateral lower limbs pareplegia Medication: — Clinical Procedure: Percutaneous transluminal angioplasty and thoracic endovascular repair followed by bilateral hemilaminectomy Specialty: Surgery OBJECTIVE: Rare disease BACKGROUND: Coarctation of the aorta is characterized by narrowing of the descending aorta. The narrowing typically is at the isthmus, the segment just distal to the left subclavian artery. Adults with undiagnosed aortic coarctation are asymptomatic or may present with nonspecific hypertension. We present a case that highlights the uncommon complication of aortic coarctation with spinal compression syndrome. CASE REPORT: A 45-year-old male presented to the emergency department (ED) with acute-onset chest pain; he experienced urinary incontinence and bilateral lower limb weakness during his ED visit. Chest CT showed coarctation of the aorta and MRI of the spine showed an epidural nodular lesion. He received emergency aortic stent placement surgery, followed by successful hematoma removal and was discharged with residual lower-extremity paraplegia. CONCLUSIONS: Chest pain with lower limb paraplegia presentation should consider aortic coarctation complicated with spinal hemorrhage as a possible cause.