Ischaemic cauda equina syndrome: an atypical presentation of acute aortic occlusion

Ischaemic cauda equina syndrome (ICES) is an uncommon but severe condition resulting from impaired blood supply to the cauda equina, often due to vascular events such as acute aortic occlusion (AAO). While AAO usually affects distal organs, it may compromise the lumbar radicular arteries, causing spinal cord ischaemia. This case describes a middle-aged patient who presented with back pain, urinary incontinence and paraplegia. Initial lumbar spine MRI was unremarkable; however, a loss of flow void in the abdominal aorta led to CT angiography, which revealed extensive infrarenal aortic thrombosis involving the lumbar arteries, confirming ICES. Despite urgent thromboembolectomy, inadequate reperfusion resulted in worsening neurological deficits and lower limb ischaemia, eventually necessitating amputation. This case illustrates the atypical manifestation of AAO as cauda equina syndrome and emphasises the need to consider vascular causes when imaging is inconclusive. Prompt recognition and management are essential to reduce the risk of severe complications. .