Acute paraplegia is a neurological emergency requiring prompt diagnosis to prevent irreversible neurological deficits and permanent disability. Although traumatic causes of acute paraplegia are well-characterized, non-traumatic acute paraplegia poses a diagnostic challenge because of its diverse etiologies. Leriche syndrome, also known as aortoiliac occlusive disease, typically presents with chronic lower-extremity claudication, diminished femoral pulses, and erectile dysfunction; however, it can rarely present with acute paraplegia and mimic a spinal cord emergency. We report the case of a 58-year-old woman with uncontrolled diabetes who presented to the emergency department with sudden-onset, non-traumatic flaccid paraplegia, accompanied by sensory loss below the level of L1 and urinary retention. Physical examination revealed cold bilateral lower extremities with absent bilateral femoral and distal pulses, raising suspicion for an acute vascular etiology. Computed tomography angiography revealed complete occlusion of the abdominal aorta and bilateral common iliac arteries at the L1-L2 level, consistent with acute Leriche syndrome. The patient was treated with intravenous heparin, followed by catheter-directed thrombolysis and aortic stent placement. Her motor function improved from 0/5 at admission to 3/5 at hospital discharge, with substantial neurological recovery during the three-month follow-up while undergoing physiotherapy. This case demonstrates that acute Leriche syndrome may present with acute paraplegia and mimic a spinal cord emergency. It highlights the critical importance of incorporating vascular assessment into the evaluation of non-traumatic acute paraplegia, as timely diagnosis and revascularization may improve neurological outcomes.

Leriche syndrome (LS) is an aortoiliac occlusive disease (AIOD) characterized by claudication, decreased femoral pulses, and erectile dysfunction. We present an LS case with bilateral femoropopliteal occlusive disease (FPOD) considered untreatable with surgery or endovascular therapy alone but successfully revascularized via hybrid intervention (HI). An 84-year-old woman with a history of LS was admitted to our hospital with rest pain in the right leg, and coldness and numbness in the left leg. The ankle-brachial index (ABI) indicated severe bilateral amplitude reduction and pulse elongation. Computed tomography angiography revealed occlusion of the terminal aorta, bilateral common iliac artery to external iliac artery, common femoral artery to superficial femoral artery, and right popliteal artery with poor run-off. We initially decided to perform HI only on the right lower extremity. Easy guidewire passage through the occluded lesion suggested a primarily thrombotic nature. HI using Fogarty arterial thrombectomy was eventually performed for the bilateral lower extremities. Complete revascularization was achieved using covered and self-expanding stents for aortoiliac lesions, and drug-eluting stent deployment and drug-coated balloon angioplasty for FPOD. The post-operative ABI was elevated, and symptoms improved bilaterally. This HI is highly effective for treating AIOD combined with bilateral FPOD involving thrombotic lesions.

Degenerative cervical myelopathy (DCM) is a progressive condition most caused by degenerative changes that lead to spinal canal stenosis and characteristic neurologic deficits involving both upper and lower extremities. We report an atypical presentation of DCM manifesting exclusively as new-onset lower extremity weakness following lumbar decompression surgery, without neck pain or upper extremity symptoms. This case highlights the importance of maintaining a high index of suspicion for cervical myelopathy and performing whole-spine imaging in patients with unexplained postoperative neurologic deficits.

Background and objective Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and a powerful predictor of coronary and cerebrovascular events, yet it is frequently underdiagnosed, particularly in primary care and resource-limited settings. The ankle-brachial pressure index (ABPI) is an inexpensive, noninvasive, first-line test, whereas arterial duplex ultrasonography provides anatomical and hemodynamic information that can guide revascularization. The objective of this study was to correlate the ABPI and clinical findings with arterial duplex scan findings in the evaluation of lower-limb PAD. Materials and methods This descriptive cross-sectional study enrolled 50 patients with clinically suspected chronic lower-limb arterial occlusive disease admitted to the Department of Surgery, Dhaka Medical College Hospital, between September 2018 and March 2019. All patients underwent history taking, clinical examination, ABPI measurement, and arterial duplex ultrasonography of the affected limb. An ABPI of 0.90 or less, supported by clinical findings, was considered positive for PAD, and stenosis or occlusion on duplex was taken as the imaging finding of interest. Agreement between ABPI plus clinical findings and duplex was assessed, and the corresponding diagnostic performance was calculated. Analyses were performed using IBM SPSS Statistics for Windows, version 20.0 (released 2011; IBM Corp., Armonk, NY, USA), with P < 0.05 considered statistically significant. Results The mean age was 53.4 ± 11.5 years, and 82.0% of patients were male (male-to-female ratio, 4.5:1). Smoking (88.0%) was the most frequent risk factor, followed by diabetes mellitus (64.0%), hypertension (58.0%), and obesity (44.0%). Intermittent claudication and muscle cramping (68.0% each) were the most common symptoms, and all patients had tissue loss (gangrene or ulceration). ABPI indicated moderate disease (0.41-0.70) in 38.0% of patients, mild disease (0.71-0.90) in 28.0%, and severe disease (<0.40) in 16.0%. Duplex demonstrated stenosis or occlusion in 76.0% of patients. ABPI combined with clinical findings showed a sensitivity of 90.2%, specificity of 88.9%, positive predictive value of 97.3%, and overall accuracy of 90.0%, with a statistically significant association with duplex findings (P = 0.0001). Conclusions ABPI combined with clinical assessment correlated strongly with duplex ultrasonography and provided an accurate, accessible approach to the diagnosis of lower-limb PAD. The combined use of physiological and imaging data supports earlier diagnosis and rational treatment planning, an advantage that is especially relevant in resource-limited settings.

Surgical exposure of the paravisceral and supraceliac abdominal aorta through traditional anterior transperitoneal and lateral retroperitoneal approaches are limited by fragmented operative fields and restricted access to right-sided vasculature. We report the technique of a midline transperitoneal infrapancreatic approach to the supraceliac aorta in a 73-year-old man requiring transaortic paravisceral thrombectomy and aortobifemoral bypass grafting for lower-extremity lifestyle-limiting claudication secondary to extensive paravisceral and aortoiliofemoral atherosclerotic disease. Through a midline transperitoneal incision, the pancreas is reflected anterosuperiorly, and dissection is extended cephalad to obtain supraceliac aortic control, thus allowing uninterrupted contiguous exposure of the entire abdominal aorta within a single operative field. This exposure facilitates secure proximal control and complex aortic reconstruction without the need for medial visceral rotation. This technique demonstrates that extension of the infrapancreatic approach to the supraceliac aorta provides continuous aortic exposure while preserving right-sided vascular access and avoiding extensive visceral mobilization, representing a valuable strategy for the management of complex aortic pathology.