Atypical Presentation of Silent Aortic Coarctation in an Adolescent Female Presenting with Sudden-Onset Paraplegia | ||||
| The Egyptian Journal of Hospital Medicine | ||||
| Article 24, Volume 100, Issue 1, July 2025, Page 2687-2689 PDF (539.12 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejhm.2025.436791 | ||||
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| Abstract | ||||
| Background: Aortic coarctation (CoA) is a prevalent congenital heart anomaly, accounting for 5-8% of congenital heart diseases and occurring at an incidence of 4 per 10,000 live births. While its presentation varies, ranging from cardiovascular collapse in neonates with severe CoA to chronic hypertension in adults, spinal neurovascular complications are rare. The formation of collateral arteries is a compensatory mechanism for obstructed aortic arch blood flow. Rarely, intraspinal collaterals and hypertrophied spinal arteries may contribute to compressive myelopathy. Objective: This study aimed to report an atypical presentation of previously silent aortic coarctation manifesting as sudden-onset paraplegia due to spinal epidural hematoma from ruptured collateral vessels. Methods: This case report detailed the clinical presentation, diagnostic workup, and management of a 13-years-old female. Diagnostic tools included spinal cord magnetic resonance imaging (MRI) with contrast and CT aortography. Results: A 13-years-old female presented with sudden-onset bilateral lower limb symmetric paralysis. MRI revealed an abnormal intramedullary cord signal with a small epidural hematoma and multiple epidural vessels. CT aortography confirmed significant postductal aortic coarctation distal to the left subclavian artery, with extensive perivertebral and dilated intraspinal/paraspinal collateral arteries. One of these engorged collateral vessels ruptured, causing spinal cord compression and acute paraplegia. A Cheatham-Platinum stent was successfully implanted. Conclusion: This case highlighted that previously undiagnosed aortic coarctation can present atypically with acute paraplegia due to spinal epidural hematoma from ruptured collateral vessels. Comprehensive vascular evaluation, including CT angiography, is crucial for accurate diagnosis and timely management in such rare presentations. | ||||
| Keywords | ||||
| Aortic coarctation; Paraplegia; Epidural hematoma; Collateral vessels; Spinal cord compression | ||||
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