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IMAGES IN NEUROLOGY
Year : 2013  |  Volume : 16  |  Issue : 3  |  Page : 402-403
 

Aortic saddle embolism and paraplegia due to a large left ventricular thrombus


1 Department of Neurology, Lourdes Hospital, Kochi, Kerala, India
2 Department of Radiology, Lourdes Hospital, Kochi, Kerala, India

Date of Submission04-Mar-2013
Date of Decision06-Jul-2013
Date of Acceptance26-Aug-2013
Date of Web Publication26-Aug-2013

Correspondence Address:
Boby Varkey Maramattom
Department of Neurology, Lourdes Hospital, Kochi - 682 006, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.116960

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How to cite this article:
Maramattom BV, Yousef SR, Joseph G. Aortic saddle embolism and paraplegia due to a large left ventricular thrombus. Ann Indian Acad Neurol 2013;16:402-3

How to cite this URL:
Maramattom BV, Yousef SR, Joseph G. Aortic saddle embolism and paraplegia due to a large left ventricular thrombus. Ann Indian Acad Neurol [serial online] 2013 [cited 2019 Nov 19];16:402-3. Available from: http://www.annalsofian.org/text.asp?2013/16/3/402/116960


A 52-year-old man presented with an acute excruciating back pain and paraplegia with the clammy and pulseless legs, grade 0/5 power, and a sensory level at T10. 8 h later magnetic resonance imaging (MRI) spine showed bilateral psoas muscle infarction with a normal spinal cord. Computed tomography (CT) angiogram showed a thrombotic occlusion of the infra-renal aorta and a large thrombus within the left ventricle [Figure 1]. 12 h later, he developed massive melena and expired. Spinal cord imaging may be normal in up to 14% of patients with spinal infarction in the early phase, [1] although, surrogate markers such as vertebral body infarction on T2-weighted MRI may be present. [2] Nevertheless, acute paraplegia accompanied by severe back and limb pain is highly suggestive of spinal infarction. [3] Saddle aortic embolism and paraplegia from embolism of a left ventricular clot is uncommon. [4] Psoas muscle infarction on MRI has not been described with an aortic thrombo-embolic occlusion.
Figure 1: (a) Axial T2-weighted images showing high signal intensity in both psoas muscles consistent with muscle infarction. (b) Coronal reformatted image shows thrombus filling infra-renal aorta and bilateral iliac arteries. (c) Coronal reformatted post-contrast computed tomography (CT) showing bilateral renal infarcts appearing as wedge shaped non-enhancing areas. (d) Volume rendered images showing complete occlusion of the infra-renal aorta and superior mesenteric artery. (e) Bowel ischemia; dilated fluid filled ileal, and jejunal loops with non-enhancing walls. (f) Post-contrast CT image showing thrombus within the left ventricle

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   References Top

1.Robertson CE, Brown RD Jr, Wijdicks EF, Rabinstein AA. Recovery after spinal cord infarcts: Long-term outcome in 115 patients. Neurology 2012;78:114-21.  Back to cited text no. 1
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2.Yuh WT, Marsh EE 3 rd , Wang AK, Russell JW, Chiang F, Koci TM, et al. MR imaging of spinal cord and vertebral body infarction. AJNR Am J Neuroradiol 1992;13:145-54.  Back to cited text no. 2
    
3.Masson C, Pruvo JP, Meder JF, Cordonnier C, Touzé E, De La Sayette V, et al. Spinal cord infarction: Clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry 2004;75:1431-5.  Back to cited text no. 3
    
4.Olearchyk AS. Saddle embolism of the aorta with sudden paraplegia. Can J Surg 2004;47:472-3.  Back to cited text no. 4
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