J Emerg Med. 2025 Sep 17;80:91-94. doi: 10.1016/j.jemermed.2025.09.020. Online ahead of print.

BACKGROUND: Acute aortic occlusion (AAO) is a rare and catastrophic vascular emergency, typically affecting older adults and presenting with acute limb ischemia.

CASE REPORT: We report a case of a 39-year-old male chronic alcoholic and smoker who presented with severe back pain followed by sudden-onset bilateral paraplegia and multiorgan ischemia. The patient developed complete motor and sensory loss below the T10 level and urinary incontinence within an hour of symptom onset. Physical examination revealed cold, mottled lower limbs with absent femoral, tibial, and distal pulses. Computed tomography (CT) angiography showed complete occlusion of the infrarenal aorta, left renal artery occlusion with complete left kidney infarction. Despite initial consideration of spinal myelopathies, the diagnosis of AAO was made based on the vascular examination. The patient’s delayed presentation and extensive ischemia precluded revascularization, and he died within hours of presentation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the need for a high level of suspicion for AAO across a broader patient demographic, even in presentations dominated by neurological symptoms. Prompt recognition and immediate diagnosis via CT angiography are crucial for improving the outcomes in this time-sensitive and devastating condition.

PubMed:41274024 | DOI:10.1016/j.jemermed.2025.09.020