Acute Chest Pain and Paraparesis

A 63-year-old man with a history of hypertension, paroxysmal atrial fibrillation, and dyslipidemia had a sudden intense chest pain radiating to his left arm, and he lost control of his legs. He was not on anticoagulant therapy and had no history of back trauma. During transport, he was hypotensive (blood pressure 88/51), his right arm was pale, and he was not able to move his legs. ECG showed inferolateral ST-segment depressions. He was given 250 mg aspirin and morphine for pain. With intravenous fluid-replacement therapy, his blood pressure rose and the activity of his legs improved. Aortic dissection was suspected, and the patient was urgently admitted to the surgical emergency room within the university hospital. In the emergency room, his blood pressure was 108/62. Cardiac and pulmonary auscultation and abdominal palpation were normal, and peripheral pulses were symmetrical. Computed tomography of the aorta revealed a hematoma next to the ascending aorta, raising a suspicion of type A aortic dissection reaching from the ascending aorta to the beginning of the left renal artery. The aortic valve was intact.During an emergency operation, the ascending aorta and a part of the aortic arch were replaced with a prosthetic graft. The arrest time was 24 minutes, and closure of the aorta took 112 minutes. In the beginning, the patient needed vasoactive support because of hypotension but later on his hemodynamic was stable. However, the next day, the patient had to undergo a resternotomy because of postoperative bleeding. After the operation, he was hypertensive and was treated with antihypertensive medication.The patient was extubated on the second postoperative day and mobilization was started the next day, when it was noticed that the patient could not stand on his feet and coordination of his lower limbs was impaired. On the fourth postoperative day, a neurologist …