Painless acute aortic dissection with a left hemiparesis: a case report

Area of Science:

• Cardiology
• Neurology

Background:

• Acute aortic dissection is a life-threatening condition often associated with severe chest pain.
• Neurological symptoms can occur in aortic dissection but are typically accompanied by pain.

Purpose of the Study:

• To report a unique case of acute aortic dissection presenting solely with transient neurological deficits.
• To emphasize the diagnostic difficulties posed by painless aortic dissection.

Main Methods:

• Case report of a 59-year-old male with sudden onset left hemiparesis.
• Initial diagnostic workup included head computed tomography (CT) to rule out cerebrovascular accident.
• Recurrent and resolving neurological symptoms prompted further investigation.

Main Results:

• Head CT was negative for acute cerebrovascular accident.
• Patient experienced cyclical episodes of neurological deficits mimicking transient ischemic attack.
• Final diagnosis confirmed as acute aortic dissection (DeBakey type II, Stanford type A).

Conclusions:

• Painless acute aortic dissection can present with isolated neurological symptoms, mimicking stroke or transient ischemic attack.
• The absence of pain in this case significantly complicated the diagnosis.
• This case underscores the importance of considering aortic dissection in the differential diagnosis of unexplained, transient neurological deficits.