Spinal cord ischemia complicated with acute aortic dissection and intramural hematoma; report of two cases

Spinal cord ischemic injury is one of te most serious complications in patients with aortic dissection. We experienced 2 cases with severe upper back pain and paraplegia of the lower extremities as initial manifestations of acute DeBakey type IIIb aortic dissection (case 1) and aortic intramural hematoma (IMH) from ascending aorta to abdominal aorta (case 2). Paraplegia was permanent and spinal cord atrophy was proved at Th 9-10 by the magnetic resonance imaging (MRI) in case 1. The aortic IMH regressed rapidly and paraplegia was transient in case 2. The MRI obtained 18 days after the onset showed scattered small lesions within the spinal cord at Th 4-7.