Aortic occlusion causing ischemic neuropathy and paraparesis

Acute aortic occlusion can present with leg weakness.1 Occlusion of the aorta above the renal arteries could cause spinal cord ischemia by flow obstruction to the Adamkiewicz artery, whereas occlusion of the aorta below the renal arteries could cause ischemic neuropathy (by flow obstruction to the external iliac or femoral arteries). Paraparesis caused by ischemic neuropathy is uncommon. We present a case of ischemic neuropathy from aortic occlusion. A 64-year-old woman sought treatment for acute onset of severe bilateral gluteal, thigh, and lower leg pain and weakness of ankle dorsiflexion and plantar flexion. There was numbness in both feet, preservation of patellar and ankle reflexes, and absent Babinski sign. Medical history included coronary artery disease, atrial fibrillation, rheumatic heart disease, porcine mitral valve replacement, pacemaker placement, and right middle cerebral artery territory stroke with residual mild left-sided weakness. She had no history of peripheral neuropathy or diabetes mellitus. …