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Bittner T, Babbush C, Vincent AC, Rokkam V. Spinal cord infarction resulting from intramural haematoma of the thoracic aorta. BMJ Case Rep 2023; 16:e254173. [PMID: 37041042 PMCID: PMC10105982 DOI: 10.1136/bcr-2022-254173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
We present the case of a female patient in her 60s with multiple medical comorbidities who presented to the emergency department with sudden-onset tearing chest, back and abdominal pain in the setting of a hypertensive emergency. Initial CT-angiography demonstrated mild-diffuse thickening of thoracic and abdominal aorta without signs of intramural haematoma or dissection. The patient was subsequently admitted and medically managed. In the days following admission, the patient developed a small bowel obstruction and neurological deficits. Repeat imaging demonstrated an intramural haematoma extending from left subclavian artery to the diaphragm resulting in foci of spinal cord infarction. Instances of spinal cord infarction secondary to aortic intramural haematoma are rare, with a minority of cases reported as of 2020. This case report highlights a non-classic patient presentation of an intramural haematoma, shedding light onto possible clinical outcomes, treatment options and important risk factors.
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Affiliation(s)
- Tyler Bittner
- Department of Medicine, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Connor Babbush
- Department of Medicine, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Ashley Chey Vincent
- Department of Medicine, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
| | - Venkata Rokkam
- Department of Medicine, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
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Yip A, Libhaber E, Nam P, Kleinloog R, Rampini L, Hosking C. A Systematic Review of Acute Thoracic Aortic Dissections in Africa-The Need for a Registry. AORTA (STAMFORD, CONN.) 2022; 10:279-289. [PMID: 36539145 PMCID: PMC9767780 DOI: 10.1055/s-0042-1757797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this systematic review, the available literature on the presentation and management of acute thoracic aortic dissections in Africa is examined. Though Africa has 17% of the world population, it accounts for approximately 1% of the available literature with much of our understanding coming from registries arising from the developed world, such as the International Registry of Acute Aortic Dissection. The literature from the African continent consists mainly of case reports, small case series, and few original studies. Case reports make an important contribution to our understanding of uncommon conditions but can skew our understanding of aortic dissections in this region by describing unusual presentations and management. In this review, we describe the available studies retrieved from large medical databases (Medline and Health Management Information Consortium) and motivate the need for national registries to provide a more accurate appreciation of the scope of the problem on this continent.
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Affiliation(s)
- Anthony Yip
- Department of Cardiology, Life Fourways Hospital, Johannesburg, South Africa,Address for correspondence Anthony Yip, MD Life Fourways Hospital Suite C28Cedar Road & Cedar Avenue West, Fourways, Johannesburg 2055South Africa
| | - Elena Libhaber
- School of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Penelope Nam
- Department of Cardiology, Life Fourways Hospital, Johannesburg, South Africa
| | - Robert Kleinloog
- Department of Cardiothoracic Surgery, Ethekweni Heart Centre and Busamed Gateway Private Hospital, Durban, South Africa
| | - Lorenzo Rampini
- Department of Cardiothoracic Surgery, Olivedale Clinic, Johannesburg, South Africa
| | - Catherine Hosking
- Department of Anesthesiology, Morningside Medi-Clinic, Johannesburg, South Africa
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Wang C, Wang B, Lv Z, Zhi J, Yang J, Hao Y. Painless aortic dissection presenting as pseudo ileus: A case report. Exp Ther Med 2022; 23:415. [PMID: 35601071 PMCID: PMC9117947 DOI: 10.3892/etm.2022.11342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Aortic dissection is a serious acute cardiovascular disease with rapid onset, progression and a high mortality rate. Due to the range of different branching vessels involved, the clinical symptoms are complex and diverse. The typical clinical symptom is a severe tearing pain in the chest, back or abdomen, but some patients also have atypical symptoms, which are easily missed or misdiagnosed and can be life-threatening. The present study reports a case of painless type B aortic dissection, initially diagnosed as ileus. The objective of this study is to enhance the clinical understanding of painless aortic dissection so that the disease can be quickly and accurately detected, and treated in a timely manner, thereby improving patient outcomes.
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Affiliation(s)
- Chunhua Wang
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Bo Wang
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Zanmei Lv
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Jia Zhi
- Department of Gastroenterology, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
| | - Jie Yang
- Outpatient Department, The Xicheng 4th Rest Center for Retired Cadres of Beijing Garrison Area of the People's Liberation Army, Beijing 100032, P.R. China
| | - Yuqing Hao
- Department of Clinical Laboratory, The 980th Hospital of the People's Liberation Army Joint Service (Bethune International Peace Hospital), Shijiazhuang, Hebei 050082, P.R. China
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Bouardi NEL, Chtaou N, Haloua M, Alami B, Youssef AL, Boubbou M, Belahsen F, Maaroufi M. Spinal cord infarction complicating acute aortic syndrome: about 2 cases. Radiol Case Rep 2022; 17:587-591. [PMID: 34976264 PMCID: PMC8688165 DOI: 10.1016/j.radcr.2021.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. It remains however a rare neurological complication in acute aortic injuries. In this context, aortic dissection is the most frequent etiological factor. Acute aortic intra mural hematoma and atheromatous penetrating ulcer remain exceptional. We encountered two cases of spinal cord infarction associated with acute aortic intra mural hematoma in one case and atheromatous penetrating ulcer in the other case that presented without typical severe pain. Thus, acute aortic injuries should be considered a cause of spinal cord infarction even if there is little or no pain.
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Affiliation(s)
- Nizar EL Bouardi
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
- Corresponding author.
| | - Naïma Chtaou
- Neurology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Meriam Haloua
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Badreddine Alami
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Alaoui Lamrani Youssef
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Meriem Boubbou
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Faouzi Belahsen
- Neurology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
| | - Mustapha Maaroufi
- Radiology department, Hassan II university hospital, Fez, Morocco
- Faculty of medicine and pharmacy, Sidi Mohammed Ben Abdellah university, Fez, Morocco
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Elshony H, Idris A, Ahmed A, Almaghrabi M, Ahmed W, Fallatah S. Spinal Cord Ischemia Secondary to Aortic Dissection: Case Report with Literature Review for Different Clinical Presentations, Risk Factors, Radiological Findings, Therapeutic Modalities, and Outcome. Case Rep Neurol 2021; 13:634-655. [PMID: 34720966 PMCID: PMC8543361 DOI: 10.1159/000518197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/29/2021] [Indexed: 12/12/2022] Open
Abstract
Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl's eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.
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Affiliation(s)
- Hosna Elshony
- Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt
| | - Abdelrahman Idris
- Department of Neurology/Internal medicine, Security Forces Hospital, Makkah, Saudi Arabia
| | - Alaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Walaa Ahmed
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Shouq Fallatah
- Faculty of Medicine, Taif University, Taif, Saudi Arabia
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Abstract
Context: Non-traumatic spinal cord infarction in the young adult is usually associated with a single or multiple genetic mutations. There are certain gene mutations that are more commonly associated with spinal cord infarctions. Homozygous or heterozygous mutations, and single mutations or polymorphism, do not seem to determine the probability of spinal cord infarction.Findings: We add another case of spinal cord infarction in a young adult to the few reported in the literature, and discuss the value of genetic studies and genetic counseling.Conclusion: Non-traumatic spinal cord infarction is usually caused by a genetic mutation. Early recognition of this entity and definition of the mutation will limit unnecessary and invasive procedures and allows early rehabilitation, preventive measures for complications and genetic counseling.
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Affiliation(s)
- Maria Khoueiry
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Hussein Moussa
- Department of Neurology, American University Medical Center, Beirut, Lebanon
| | - Raja Sawaya
- Department of Neurology, American University Medical Center, Beirut, Lebanon,Correspondence to: Raja Sawaya, Clinical Neurophysiology Laboratory, AmericanUniversity Medical Center, POB: 113 - 6044 / C-27, Beirut, Lebanon; Ph: 00-961-3347377.
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Mathew T, John SK, Sharath Kumar GG. "Acute Onset Paraplegia-Look at the Aorta, if Spinal Cord Imaging is Normal". Neurol India 2021; 69:1127-1128. [PMID: 34507481 DOI: 10.4103/0028-3886.325372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Thomas Mathew
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India
| | - Saji K John
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India
| | - G G Sharath Kumar
- Department of Neurology, St. John's Medical College Hospital, Sarjapura Road, Bengaluru, Karnataka, India
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Yasuda N, Kuroda Y, Ito T, Sasaki M, Oka S, Ukai R, Nakanishi K, Mikami T, Shibata T, Harada R, Naraoka S, Kamada T, Kawaharada N. Postoperative spinal cord ischaemia: magnetic resonance imaging and clinical features. Eur J Cardiothorac Surg 2021; 60:164-174. [PMID: 33517384 DOI: 10.1093/ejcts/ezaa476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Ischaemic spinal cord injury (SCI) is one of the most serious complications of aortic surgery. Ischaemic SCIs occur due to various aetiologies, and prediction of the risk is difficult. Magnetic resonance imaging (MRI) is useful to detect the details of spinal cord infarction. There are few studies about MRI for evaluating ischaemic SCI after cardiovascular surgery and aortic events. We report 9 cases of postoperative ischaemic SCI and analyse their MRI features. METHODS T2-weighted MRI scans of 9 patients who developed ischaemic SCI due to cardiovascular surgery and aortic events between 2012 and 2017 were evaluated. RESULTS In all patients, high-intensity areas were observed on T2-weighted magnetic resonance images. The site of infarction was the thoracic spinal cord level (9 cases) and additionally at the lumbar spinal cord level (5 cases). The area of infarction area was categorized based on the arterial territory: anterior spinal artery territory (3 cases), posterior spinal artery territory (2 cases), spinal sulcal artery territory (1 case) and artery of Adamkiewicz territory (3 cases). CONCLUSIONS MRI revealed the infarction sites in all cases and the differences in the infarction patterns in each case. MRI could thus be useful for investigating the aetiology of ischaemic SCI following aortic surgeries and events.
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Affiliation(s)
- Naomi Yasuda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Cardio Vascular Clinic, Sapporo, Hokkaido, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, Japan
| | - Masanori Sasaki
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shinichi Oka
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Ukai
- Department of Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Keitaro Nakanishi
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Spinal Cord Infarction with Aortic Dissection. Case Rep Orthop 2018; 2018:7042829. [PMID: 30050713 PMCID: PMC6046175 DOI: 10.1155/2018/7042829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
Spinal cord infarction is an uncommon but devastating disorder caused by various conditions. Aortic dissection is a possible etiological factor and is usually associated with severe chest or back pain. We encountered two cases of spinal cord infarction associated with aortic dissection that presented without typical severe pain, and each case resulted in a different clinical course. Aortic dissection should be considered a cause of spinal cord infarction even if there is little or no pain. The different outcomes in our two patients reflected a difference in their initial functional scores.
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Long B, Koyfman A. Vascular Causes of Syncope: An Emergency Medicine Review. J Emerg Med 2017; 53:322-332. [PMID: 28662832 DOI: 10.1016/j.jemermed.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Syncope is a common emergency department (ED) complaint, accounting for 2% of visits annually. A wide variety of etiologies can result in syncope, and vascular causes may be deadly. OBJECTIVE This review evaluates vascular causes of syncope and their evaluation and management in the ED. DISCUSSION Syncope is defined by a brief loss of consciousness with loss of postural tone and complete, spontaneous recovery without medical intervention. Causes include cardiac, vasovagal, orthostatic, neurologic, medication-related, and idiopathic, and most cases of syncope will not receive a specific diagnosis pertaining to the cause. Emergency physicians are most concerned with life-threatening causes such as dysrhythmia and obstruction, and electrocardiogram is a primary means of evaluation. However, vascular etiologies can result in patient morbidity and mortality. These conditions include pulmonary embolism, subclavian steal, aortic dissection, cerebrovascular disease, intracerebral hemorrhage, carotid/vertebral dissection, and abdominal aortic aneurysm. A focused history and physical examination can assist emergency physicians in determining the need for further testing and management. CONCLUSIONS Syncope is common and may be the result of a deadly condition. The emergency physician, through history and physical examination, can determine the need for further evaluation and resuscitation of these patients, with consideration of vascular etiologies of syncope.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Prakash B, Pai RK, Chaitra V, Ramasamy P, Shuba N. A Case of Acute Paraplegia Due to Aortic Dissection in Marfan Syndrome. J Neurosci Rural Pract 2017; 8:316-319. [PMID: 28479826 PMCID: PMC5402518 DOI: 10.4103/0976-3147.203825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- B. Prakash
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - R. Krishnanand Pai
- Department of Cardiothoracic and Vascular Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - V. Chaitra
- Department of Pathology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - P. Ramasamy
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - N. Shuba
- Department of Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Bekele E, Kagolanu DC, Kim M, Stephenson K. More than just muscle spasms: a rare presentation of aortic dissection. BMJ Case Rep 2017; 2017:bcr-2016-218432. [PMID: 28343155 DOI: 10.1136/bcr-2016-218432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Acute aortic dissection is associated with significant morbidity and mortality, often from complications including aortic regurgitation, cardiac tamponade and myocardial infarction. Typical clinical presentation includes a sudden onset of severe chest pain, although this is not always consistent. Clinical signs and symptoms are diverse with an estimated 38% of cases being missed on initial evaluation. Primary neurological symptoms at presentation are rare but have been reported often to coexist with chest pain. We present a case of acute aortic dissection in which the initial presenting symptoms were predominantly neurological. Stanford type A dissection is a surgical emergency with a high burden of cardiovascular death; thus, aggressive identification and management is paramount. Our case re-emphasises the importance of having a higher index of suspicion and a keen clinical eye for atypical presentations of acute aortic dissection.
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Affiliation(s)
- Ebisa Bekele
- Nassau University Medical Center, East Meadow, New York, USA
| | | | - Martin Kim
- Nassau University Medical Center, East Meadow, New York, USA
| | - Kent Stephenson
- Nassau University Medical Center, East Meadow, New York, USA
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