Abstract: Objective To investigate the occurrence and prognosis of aortic dissection (AD) with neurological symptoms as the first symptom. Methods Clinical data of a case of AD with weakness and numbness of both lower limbs as the initial manifestation were retrospectively analyzed. Relevant literatures were reviewed as well. Results A 32-year-old male patient presented with numbness and weakness of both lower limbs for 1 hour. He had previous history of hypertension. One hour before admission, he suddenly appeared numbness and weakness of both lower limbs when riding a bicycle, and the symptoms progressed rapidly. Within 10 minutes, the strength of both lower limbs completely disappeared. Neurological examination showed grade 0 of limb muscle strength on both lower limbs, and decreased muscle tension. Bilateral knee and ankle reflexes were not elicited. Depth and superficial sensation below the plane of the 12th thoracic vertebra (T12) were lost. Babinski sign of both lower limbs was negative. Combined with coagulation routine test, cardiac ultrasound and aortic CT angiography, the patient was diagnosed as AD (Starnfor type A). However, the patient and his family refused surgical treatment, and later died after the failure of conservative treatment. Conclusion AD neurological symptoms as the first symptom is rare. This paper reporteda case of AD with isolated spinal cord injury and absence of painful symptoms as the first presentation. Through literature review, our case report provided references for clinical improvement of diagnosis and treatment and reduction of mortality rate.

Key words: aneurysm dissection, weakness of lower limb, case report