Acute paraplegia in a patient with repaired coarctation of aorta

A 77-year-old neurologically intact woman presented in hypertensive crisis (blood pressure [BP] 220/110 mm Hg) resulting in pulmonary edema. The patient had a history of remote (over 40 years) repaired aortic coarctation, breast cancer in remission, hypertension managed with 6 antihypertensive medications, and allergy to iodinated contrast. Her BP was reduced to as low as 134/26 mm Hg. Subsequently she developed acute paraplegia. Examination revealed nonlocalizing lower back and abdominal pain. Tibial pulses were absent, but extremities remained warm to touch. On neurologic examination, the abnormal findings were present only in the lower extremities, which were both flaccid with 0/5 strength and 0/4 deep tendon reflexes. Plantar responses were mute. Sensory perception to all primary sensory modalities was absent with a sensory level to pinprick at L1 dermatome. She was unable to generate rectal sphincter tone. Bladder dysfunction could not be assessed due to Foley catheter in place.