Case Report: Acute painless paraplegia revealing Stanford type A aortic dissection

Abstract* Background Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency that typically presents with sudden severe chest or back pain. Neurological manifestations are uncommon, and acute painless paraplegia secondary to spinal cord ischemia is an exceptionally rare presentation that may delay diagnosis. Case Presentation We report the case of a 64-year-old man with a history of uncontrolled hypertension, heavy smoking, and previous ischemic stroke who presented with sudden painless paraplegia. Prehospital examination revealed flaccid paraplegia, a sensory level at T4, and preserved peripheral pulses. Although blood pressure was initially symmetrical, marked fluctuations were observed during transport, raising suspicion of an acute vascular event. Chest radiography demonstrated mediastinal widening, and computed tomography angiography confirmed a Stanford type A acute aortic dissection. The patient underwent emergency surgical repair. His postoperative course was favorable, with complete neurological recovery following intensive motor rehabilitation. Conclusion Although exceedingly rare, acute aortic dissection should be considered in the differential diagnosis of sudden painless paraplegia, even in the absence of chest or back pain. Early recognition of subtle clinical clues and prompt aortic imaging are crucial to facilitate timely surgical treatment and optimize neurological outcomes.