Background and aims: Acute flaccid paralysis is a clinical syndrome with a broad array of potential etiologies, infrequently occurred after ischemic pathology of the spinal cord. Spinal cord ischemia has been reported after thoracic and abdominal aorta surgery, and rarely after interruption of the cord blood supply by embolism at the aortic bifurcation (saddle embolus). Acute aortoiliac occlusion (AAO) is a catastrophic event with high incidence of neurological complications and it is frequently accompanied by myocardial dysfunction. Case Report: We report a case of a 57-year-old man who developed severe back pain with acute lower extremities paralysis, coldness and pallor in the lower limb (march 2014). There was no weakness in the upper extremities, sphincter muscles of bladder and bowel. His past medical history included a myocardial infarct (2007). Results: A CT-angiography revealed a segmental occlusion of the distal infrarenal aorta and bilateral common iliac arteries. The transthoracic echocardiography demonstrated a left ventricular aneurysm with mural thrombus, which was the source of this acute spinal cord ischemia. The patient underwent aorto-bifemoral by-pass surgery. Despite this intervention, the paralysis persisted. Conclusion: Sudden onset of flaccid paralysis should immediately alert the physician, because this cardinal symptom can denote an AAO. This case highligts that AAO needs early recognition, prompt diagnosis and immediate intervention. Disclosure: Nothing to disclose