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Painless acute aortic dissection with a left hemiparesis.
Seiji Morita1, Masayoshi Shibata, Yoshihide Nakagawa
1Tokai University School of Medicine, Department of Emergency and Critical Care Medicine, Bouseidai Isehara-City Kanagawa 259-1142, Japan. morito@is.icc.u-tokai.ac.jp
Neurocritical Care
|June 8, 2006
Summary
Painless acute aortic dissection can mimic stroke. Three cases of painless acute aortic dissection presenting as left hemiparesis highlight this diagnostic challenge, emphasizing the need for broader differential diagnoses in neurological emergencies.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Acute aortic dissection (AAD) diagnosis is challenging in patients presenting solely with neurological deficits and no pain.
- Neurological symptoms can be the primary or only manifestation of AAD, complicating early recognition.
Observation:
- Three patients with painless acute aortic dissection (DeBakey Type II, Stanford Type A) presented with sudden onset left hemiparesis.
- Initial clinical suspicion was ischemic stroke due to the neurological presentation.
Findings:
- Diagnosis of acute aortic dissection was confirmed in all three patients.
- Innominate artery dissection was identified as the cause of hemiparesis, likely due to dominant false lumen flow.
- All patients exhibited a wide mediastinum on plain chest X-ray.
Implications:
- This case series underscores the existence of highly unusual presentations of aortic dissection mimicking acute ischemic stroke.
- Clinicians should consider aortic dissection in the differential diagnosis of stroke, especially when a wide mediastinum is observed.
- Prompt recognition and diagnosis of painless aortic dissection are critical for timely surgical intervention and improved patient outcomes.