Isolated Infrarenal Aortic Dissection Presenting With Predominant Neurological Symptoms Without Limb Ischemia: A Case Report

Isolated abdominal aortic dissection (IAAD) is a rare clinical entity, particularly when confined to the infrarenal segment. The presentation is often atypical, leading to delayed diagnosis. We present the case of a 60-year-old female with a history of hypertension who presented to the emergency department with a five-day history of right lower limb pain and inability to stand. Her symptoms began as a sudden, severe, electric shock-like pain in the right flank radiating down the right leg, which subsided after 15 minutes and was replaced by persistent numbness and generalized weakness. Physical examination revealed normal lower limb coloration, palpable pulses, and no signs of acute limb ischemia, lacking the classic five Ps. Echocardiography was unremarkable for proximal aortic pathology. Abdominal CT angiography (CTA) revealed an isolated infrarenal aortic dissection extending to the aortic bifurcation and terminating in the right iliac arteries, with a completely thrombosed false lumen. Given the persistent symptoms suggestive of malperfusion and the absence of suitable endovascular landing zones, the patient underwent an open aortobifemoral bypass using a polytetrafluoroethylene graft. Postoperatively, her neurological symptoms resolved completely, and she was discharged on the 10thpostoperative day without complications. This case highlights the importance of considering aortic dissection in patients presenting with unexplained neurological symptoms, even in the absence of overt limb ischemia. Early diagnosis with CTA and appropriate surgical intervention can lead to excellent outcomes.