Abstract
Background
Patients who present with only neurological symptoms and no pain challenge the recognition of acute aortic dissection.
Results
We report three patients with completely painless acute aortic dissection who presented with left hemiparesis. All patients presented with a left-sided weakness of sudden onset. We suspected an ischemic stroke but diagnosed acute aortic dissection (DeBakey Type II, Stanford Type A). We suspect that the innominate artery is occluded when the blood flow of the false lumen is dominant. In our cases, surgical and autopsy findings showed dissection of the innominate artery.
Conclusions
Highly unusual presentations of aortic dissection with acute ischemic stroke exist. A wide mediastinum on plain chest X-ray was present in all cases.
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References
Vech RJ, Besterman EMM, Bromley LL, et al. Acute aortic dissection historical perspective and current management. Am Heart 1981; 102:1087–1089.
Cohen S, Littman D. Painless dissection aneurysm of the aorta. N Engl J Med 1964;271:143–145.
Rahmatullah SI, Khan IA, Nair VM, et al. Painless limited dissection of the ascending aorta, presenting with aortic valve regurgitation. Am J Emerg Med 1999;17:700–701.
Spittell PC, Spittell JA, Joyc JW, et al. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases. Mayo Clin Proc 1993;68:642–651.
Weisman AD, Adams RD, The neurological complications of dissecting aortic aneurysm. Brain 1944;67:6–92.
Koushima R, Kikuchi Y, Sakurada T., et al. A case of painless Stanford type A acute aortic dissection complicating acute occlusion of the right subclavian artery. Kyobu Geka 1998;51:226–230.
Blanco M, Diez-Tejedor E, Larrea, JL, et al. Neurologic complications of type I aortic dissection. Acta Neurol Scand 1999;99:232–235.
Flemming KD, Brown RD. Acute cerebral infarction caused by dissection: caution in the thrombolytic era. Stroke 1999;30:477–478.
Nienaber CA, Von Kodolitsch Y, Nicolas V., et al. The diagnosis of thoracic aortic dissection by noninvasive imaging procedures. N Engl J Med 1993;328:1–9.
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Morita, S., Shibata, M., Nakagawa, Y. et al. Painless acute aortic dissection with a left hemiparesis. Neurocrit Care 4, 234–236 (2006). https://doi.org/10.1385/NCC:4:3:234
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DOI: https://doi.org/10.1385/NCC:4:3:234