Acute Paraplegia Due to Spinal Cord Infarction in a Case of Takayasu Arteritis and Aortic Dissection

Abstract

Background: Spinal cord infarction is a rare but devastating cause of acute myelopathy, accounting for less than 1% of all strokes. It is most commonly associated with vascular pathologies, including aortic dissection and large-vessel vasculitis such as Takayasu arteritis. Case Presentation: We report a case of a 40-year-old female presenting with sudden-onset, painless paraplegia accompanied by sensory loss below the T4 level and autonomic dysfunction. Clinical examination revealed absent lower limb pulses and an abdominal bruit. Imaging studies demonstrated a Type B aortic dissection with extensive thoracic spinal cord infarction and features suggestive of Takayasu arteritis, including large-vessel wall thickening and stenosis. The patient was managed conservatively with careful blood pressure control, antiplatelets, corticosteroids, and supportive care including physiotherapy. A multidisciplinary approach was adopted to balance the competing priorities of aortic stabilization and spinal cord perfusion. Conclusion: This case highlights the importance of considering vascular etiologies in acute non-traumatic paraplegia. Early recognition and appropriate imaging are crucial for diagnosis. Management requires a nuanced approach to optimize neurological outcomes while preventing progression of aortic pathology.