Background: In the setting of multi-system traumas, the etiology and pathophysiology of neurologic injuries can be difficult to identify.

Methods: A unique case of a pedestrian struck by a motor vehicle that presented with acute paraplegia after an endovascular stent placement for a traumatic thoracic aorta dissection. The patient had no significant motor function in the lower extremeties, but full preservation of all sensory modalities. Initial admission computed tomography (CT) imaging was negative for intracranial trauma, but noted an acute cranial fracture; no spinal trauma was identified.

Results: The patient had a lumbar drain placed to maximize spinal perfusion pressures and was immediately evaluated with magnetic resonance imaging (MRI) of the neural axis. Acute bilateral posterior frontal contusions were identified on brain imaging, which were not present on pre-procedural CT head. No spinal cord injury or ischemia was seen on spinal imaging. The patient recovered and regained use of his lower extremeties following a short rehab stay.

Conclusions: In the setting of multi-system trauma, a high level of suspicion should exist for alternative etiologies of neurologic injuries. Thorough neurologic examinations and imaging assessments of the nervous system should be conducted to avoid misdiagnosis and improper management of occult injuries. This is the first reported case of acute paraplegia due to vertex trauma which may be a rare mechanism of injury and/or under-recognized.

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