Acute-on-chronic type B aortic dissection presenting as cauda equina syndrome

A 60-year-old woman transferred with suspected cauda equina syndrome lacked lower extremity pulses on arrival. She rapidly developed visceral malperfusion due to underlying type B aortic dissection, necessitating aortic fenestration with thrombectomy. Despite misdiagnosis and delayed treatment, she could ambulate 1 year postoperatively. Aortic dissection remains integral to the differential diagnosis of patients presenting with acute paraparesis.