Painless Acute Aortic Dissection May Present as a Stroke; Risky Markers that Could be Identified on Hospital Arrival

Acute aortic dissection (AAD) is a life-threatening emergency. A small portion of AAD patients presents as an acute stroke without chest pain. A missed or delayed diagnosis of AAD often brings catastrophic outcome. We aimed to identify clinical markers suggestive of the presence of painless AAD in acute stroke patients.

From January 2007 through December 2014, painless AAD patients were retrospectively collected from our stroke registry. We expanded the search by reviewing Medline and the Science Citation Index Expanded from 1981 until March 2015. We enrolled 200 consecutive cases of acute ischemic stroke without AAD as the control. Univariate analyses were performed to compare clinical markers, followed by logistic regression to analyze the markers with signifi cant differences.

The AAD group had more female, younger patients and fewer co-morbidities. They more frequently had consciousness disturbances (p < 0.001), were brought to the hospital sooner (p < 0.001), arrived more frequently with impaired consciousness (p = 0.001), hypotension and bradycardia (p < 0.001) and left-sided weakness (70.2%; p < 0.001). In the risk factor analysis, hypotension (OR 48.86, 95% CI 5.70-420.28), bradycardia (OR 8.11, 95% CI 2.71-24.24), initial loss of consciousness (OR 5.27, 95% CI 1.88-14.76), andleft-sided weakness (OR 3.31, 95% CI 1.17-9.40) were observed more frequently in the AAD group.

Consider to rule out a painless AAD in stroke patients presenting with hypotension, bradycardia, initial loss of consciousness, or left-sided weakness.