Acute Paraplegia in the Emergency Department: Acute Leriche Syndrome as a Vascular Mimic of a Spinal Cord Emergency

Acute paraplegia is a neurological emergency requiring prompt diagnosis to prevent irreversible neurological deficits and permanent disability. Although traumatic causes of acute paraplegia are well-characterized, non-traumatic acute paraplegia poses a diagnostic challenge because of its diverse etiologies. Leriche syndrome, also known as aortoiliac occlusive disease, typically presents with chronic lower-extremity claudication, diminished femoral pulses, and erectile dysfunction; however, it can rarely present with acute paraplegia and mimic a spinal cord emergency. We report the case of a 58-year-old woman with uncontrolled diabetes who presented to the emergency department with sudden-onset, non-traumatic flaccid paraplegia, accompanied by sensory loss below the level of L1 and urinary retention. Physical examination revealed cold bilateral lower extremities with absent bilateral femoral and distal pulses, raising suspicion for an acute vascular etiology. Computed tomography angiography revealed complete occlusion of the abdominal aorta and bilateral common iliac arteries at the L1-L2 level, consistent with acute Leriche syndrome. The patient was treated with intravenous heparin, followed by catheter-directed thrombolysis and aortic stent placement. Her motor function improved from 0/5 at admission to 3/5 at hospital discharge, with substantial neurological recovery during the three-month follow-up while undergoing physiotherapy. This case demonstrates that acute Leriche syndrome may present with acute paraplegia and mimic a spinal cord emergency. It highlights the critical importance of incorporating vascular assessment into the evaluation of non-traumatic acute paraplegia, as timely diagnosis and revascularization may improve neurological outcomes.