Acute Aortic Thrombus Presenting as Cauda Equina Syndrome.

BACKGROUND: Occlusive abdominal aortic thrombus is a rare but critical clinical emergency with life-threatening consequences. Clinical presentation may mimic other diagnoses, resulting in a delay in the appropriate investigations for this condition. Spinal arterial involvement is a recognized complication of aortic thrombus and can result in pain, lower limb weakness, and loss of continence. These symptoms are usually associated with local spinal compression or stenosis manifesting as cauda equina syndrome (CES): a clinical finding of disrupted motor and sensory function to the lower extremities and bladder. CASE REPORT: We present a case of a 60-year-old female patient presenting with back pain, leg weakness, paresthesia, and urinary incontinence. She was urgently investigated for cauda equina syndrome via a magnetic resonance imaging scan of the spine, which subsequently demonstrated a large occlusive abdominal aortic thrombus. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Nontraumatic acute thrombosis of the aorta is a life-threatening condition that may present with apparent neurological symptoms. In this patient there was both a relevant history and evolving clinical signs pointing toward a vascular etiology; however, the clinical findings were confusing and CES evaluation was prioritized. CES remains a medical emergency requiring urgent investigation and management. However, knowledge of spinal anatomy including vascular supply may help widen the differential. Physicians and associate specialists should consider this at clinical assessment and also when interpreting imaging of the spine. Any delay in diagnosing an aortic thrombosis has the potential for catastrophic clinical consequences.

Acute focal myositis causing significant radiological and histological abnormality settles spontaneously with expectant management.

We discuss two cases of reactive focal myositis that had different clinical presentations but responded well to conservative management. These cases demonstrate that reactive myositis can present acutely but resolves quickly with expectant treatment and has a favourable prognosis.

Transient migratory osteoporosis: rapid response to pamidronate treatment.

Transient migratory osteoporosis is characterized by the acute onset of migratory pain at weight-bearing joints. The diagnosis is based on clinical findings together with characteristic abnormalities on MRI or bone scan. Each attack is generally self-limiting but may take several months to resolve. We describe 2 cases of transient migratory osteoporosis to highlight their rapid response to pamidronate therapy; in addition, 1 of these cases affected the sacrum, a site not reported to be involved in this condition.