Acute Aortic Occlusion Mimicking Cauda Equina Syndrome: Complete Neurologic Recovery After Emergent Endovascular Revascularization

A 67-year-old man with a history of bilateral iliac stenting presented for acute right lower extremity weakness, numbness, and severe pain after exertion. Femoral and distal pulses were absent bilaterally. Initial suspicion during evaluation was for Cauda Equina Syndrome. However, computed tomography angiography of the abdomen and pelvis revealed an acute thrombotic occlusion of the distal abdominal aorta extending into both common iliac arteries with a 3.1-cm aneurysm. Emergency vascular intervention was performed, consisting of over-the-wire thrombectomy and endovascular stenting with adjunctive balloon angioplasty. Blood flow to both lower extremities was restored. On postoperative day one, strength and sensation normalized with palpable distal pulses. The patient experienced complete resolution of lower extremity symptoms and neurologic deficits. This case emphasizes the importance of clinical awareness, rapid diagnosis, and urgent treatment of an acute vascular condition that can mimic cauda equina syndrome.