Acute Bilateral Lower Limb Ischemia Mimicking Neurological Emergency: A Case of Leriche Syndrome.

Leriche syndrome, a rare manifestation of chronic aorto-iliac occlusive disease, may occasionally present acutely with bilateral lower limb ischemia, mimicking neurological emergencies such as cauda equina syndrome. We report a 70-year-old man presenting with sudden-onset bilateral lower limb weakness and numbness. Examination revealed cold, pulseless lower limbs. CT angiography demonstrated extensive thrombosis from the descending thoracic aorta to the iliac arteries, with complete occlusion of the right superficial femoral artery. The patient underwent urgent open embolectomy of the femoral and subclavian arteries, aorto-bifemoral bypass via axillary artery anastomoses, and bilateral lower limb fasciotomies. Although perfusion was successfully restored in the left lower limb, irreversible ischemia in the right leg necessitated an above-knee amputation. This case highlights the importance of early recognition of acute aorto-iliac thrombosis, rapid vascular imaging, and coordinated multidisciplinary intervention to optimize outcomes in this rare yet critical vascular emergency.