Ischemic stroke with left hemiparesis or shock should be evaluated by computed tomography for aortic dissection

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Stanford A-type aortic dissection is a life-threatening condition often associated with severe chest pain.
• Neurological deficits can occur but are not always the primary presenting symptom.

Observation:

• An 82-year-old female presented with altered consciousness, left hemiparesis, and dysarthria, initially in a shock state.
• Chest X-ray suggested aortic dissection, but head CT showed no cerebral infarction.
• The absence of pain led to a delayed diagnosis of acute aortic dissection.

Findings:

• The patient's stroke-like symptoms, specifically left hemiparesis, were attributed to innominate artery malcirculation secondary to aortic dissection.
• Hypotension, an unusual finding in typical stroke cases, was present, further suggesting aortic dissection as the underlying cause.
• The patient died suddenly the following day, confirming a Stanford A-type aortic dissection diagnosis.

Implications:

• Ischemic stroke is an uncommon but critical presentation of aortic dissection.
• Patients with ischemic stroke, particularly with left hemiparesis or shock, require urgent evaluation with enhanced truncal computed tomography to rule out aortic dissection.
• Misdiagnosis of aortic dissection carries high morbidity and mortality rates, underscoring the need for heightened clinical suspicion in such cases.