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A case report of painless type A aortic dissection with intermittent convulsive syncope as initial presentation
Chun-Hsien Chen1, Kuan-Ting Liu
1Department of Emergency Medicine, Kaohsiung Medical University Hospital School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine
|April 27, 2017
Summary
This case report highlights a rare presentation of acute aortic dissection. A painless type A aortic dissection initially mimicked a seizure due to cardiac asystole and convulsive syncope.
Area of Science:
- Cardiology
- Thoracic Surgery
- Emergency Medicine
Background:
- Acute aortic dissection (AAD) presents with diverse symptoms, complicating early diagnosis.
- Painless presentations and syncope due to cardiac arrhythmia are atypical for AAD.
Observation:
- A 61-year-old male presented with transient loss of consciousness and suspected seizure.
- Initial ER evaluation revealed upward gaze, limb convulsions, and transient cardiac asystole on ECG.
- Chest X-ray showed mediastinal widening, leading to CT confirmation of Stanford type A aortic dissection.
Findings:
- This is the first reported case linking cardiac asystole and convulsive syncope to a painless Stanford type A aortic dissection.
- The patient's presentation mimicked a seizure disorder due to transient arrhythmia caused by aortic dissection.
Implications:
- Clinicians should consider aortic dissection in the differential diagnosis of unexplained syncope, even with atypical symptoms.
- Prompt diagnosis and management of AAD are crucial, especially in cases presenting with neurological symptoms or cardiac events.
- This case underscores the importance of advanced imaging in diagnosing rare presentations of aortic dissection.
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