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Putative pathophysiological mechanisms in recurrent hemicrania from aortic dissection: a case report
Joseph Kamtchum Tatuene1, Sophie Excoffier2, Jean-Paul Vallee3
1Neurology Division, Department of Clinical Neurosciences, Geneva University Hospital, 4 Gabrielle-Perret-Gentil Street, 1211, Geneva 14, Switzerland. joseph.kamtchumtatuene@hcuge.ch.
BMC Research Notes
|June 18, 2015
Summary
Neurological symptoms like headache can mask aortic dissection. This case suggests new-onset headaches with chest pain may signal aortic dissection, resolving after surgical repair.
Area of Science:
- Neurology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- 17-40% of patients with aortic dissection experience neurological symptoms.
- These symptoms can mask the underlying life-threatening condition.
Observation:
- A young man presented with recurrent severe headaches and dull chest pain.
- Brain MRI was unremarkable, but CT revealed type A aortic dissection.
- Headache resolved after surgical repair of the ascending aorta.
Findings:
- The patient's headaches, initially undiagnosed as a primary headache disorder, resolved post-surgery.
- This suggests the headaches were symptomatic of aortic dissection.
- Hypothesized pathways involve aortic wall ischemia activating the trigeminovascular system.
Implications:
- Consider aortic dissection in patients with new-onset headaches and chest pain, especially when primary headache diagnoses are uncertain.
- This case highlights the importance of a thorough review of systems for potentially life-threatening conditions.
- Further research is needed to validate the proposed pathophysiological mechanisms.
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