200 Section - Paraplegia Following Polytrauma and Aortic Dissection: A Rare Case of Bilateral Ischaemic Lumbosacral Plexopathy and Its Rehabilitation Challenges.

Case Diagnosis: This patient exhibited progressive bilateral lower-limb weakness following polytrauma complicated by acute aortic dissection and TEVAR repair. Initial examination suggested an incomplete L1 spinal cord injury; however, Electrodiagnostic studies clarified the diagnosis, revealing severe bilateral lumbosacral plexopathy with loss of anatomical continuity in L5–S1 nerve root territories.

Case Description: A 20-year-old male presented following a high-speed motorcycle–car collision and was found to have multiple injuries. Clinically, he developed progressive bilateral lower limb weakness and sensory changes, initially suggestive of an incomplete L1 spinal cord injury. MRI whole spine demonstrated cord sparing, and MRI of the lumbosacral region showed no visible plexus lesion, delaying localisation. Despite stable imaging, his weakness progressed with distal and asymmetric features atypical for a thoracic cord lesion. Electrodiagnostic studies confirmed severe bilateral lumbosacral plexopathy likely secondary to vascular compromise from the aortic injury and repair. He underwent specialist rehabilitation including gait retraining, neuromuscular re-education, orthotic support, and psychological management. The case highlights the importance of integrating imaging, electrodiagnostic studies, and vascular history to accurately diagnose complex neurological presentations following high-energy trauma and vascular interventions.

Discussions: Bilateral ischemic lumbosacral plexopathy secondary to aortic dissection and TEVAR repair is exceptionally rare. This case illustrates the diagnostic challenge when vascular and traumatic mechanisms overlap, as ischemic plexopathy can mimic spinal cord injury. Multidisciplinary rehabilitation was critical for meaningful recovery. Clinicians should maintain a high index of suspicion for ischemic peripheral nerve injury in patients with polytrauma and vascular compromise, and EMG should be considered when imaging is inconclusive. Early recognition guides prognosis and targeted rehabilitation planning.

Conclusions: Once bilateral lumbosacral plexopathy complication occurs, careful neurologic evaluation should be done to localise the lesion and aid prognosis. EMG is essential for diagnosis, and multidisciplinary rehabilitation is critical to optimise functional recovery and long-term outcomes.