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Stroke, Vol 23, 1660-1661, Copyright © 1992 by American Heart Association

ARTICLES

The role of transesophageal echocardiography in the acute onset of paraplegia

DV Walsh, JA Uppal, DG Karalis and K Chandrasekaran
Likoff Cardiovascular Institute, Department of Medicine, Hahnemann University Hospital, Philadelphia, PA 19102.

BACKGROUND AND PURPOSE: Acute paraplegia must be investigated promptly to exclude reversible causes. In this report we illustrate the usefulness of transesophageal echocardiography in identifying the vascular etiologies of acute paraplegia. CASE DESCRIPTIONS: Two patients presented with acute paraplegia, one spontaneously and the other after removal of an intra-aortic balloon pump catheter. Through the use of transesophageal echocardiography, we excluded aortic dissection and identified protruding atherosclerotic plaques in the descending thoracic aorta of each patient. Embolization of atheromatous material from the thoracic aorta was considered the most likely etiology of paraplegia in both cases. CONCLUSIONS: Embolization from atherosclerotic plaques in the thoracic aorta may be an underestimated cause of acute paraplegia. Transesophageal echocardiography provides a safe, rapid, and reliable tool for investigating a vascular etiology of acute paraplegia.