History and clinical findings: A 70-year-old woman with acute chest pain was admitted to a hospital in stable cardiovascular conditions. The patient had no history of cardio-circulatory disease.
Investigations: An acute myocardial infarction was excluded by ECG and blood tests. A computed tomography (CT) revealed an aortic dissection (Stanford type A) which extended to the left subclavian artery.
Treatment and course: She was transferred to our institution and underwent urgent operation during which the ascending aorta and the proximal arch were replaced by a prosthesis. A few days after surgery, she developed progressive paresis of both legs. A control CT scan of the aorta revealed no evidence of a persisting aortic dissection. However, magnetic resonance tomography showed a meningioma of the thoracic spinal cord. The patient underwent surgical resection of the meningioma and her neurological symptoms diminished over the next few days.
Conclusion: Besides spinal ischemia, paresis of both legs after acute aortic dissection may be caused by rare lesions such as a thoracic meningioma.