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01 December 2019 : Case report  Romania

Aortic Dissection: An Easily Missed Diagnosis when Pain Doesn’t Hold the Stage

Challenging differential diagnosis

Maria Mirabela Manea12ABEFG, Dorin Dragos34CDE*, Florian Antonescu12B, Adrian George Sirbu56BD, Andreea Taisia Tiron78CD, Ana Maria Dobri2D, Sorin Tuta12CDG

DOI: 10.12659/AJCR.917179

Am J Case Rep 2019; 20:1788-1792

Abstract

BACKGROUND: Type A aortic dissection (AD) is a rare disease, with a high mortality rate. Its most common symptom is thoracic pain, which is nevertheless absent in about 6% of cases. Neurologic complications are extremely rare and include ischemic stroke and ischemic neuropathy (which are the most common as presenting symptoms), spinal cord ischemia, and hypoxic encephalopathy. These rare neurological presentations can often be missed at initial clinical examination.

CASE REPORT: We report 2 cases of patients presenting with seemingly mild neurological symptoms. However, diagnostic tests revealed acute type A AD, and further steps were taken.

CONCLUSIONS: Although it is a rare cause of transient stroke or peripheral nerve ischemia, AD should be quickly recognized as a potential cause of new-onset neurological manifestations.

Keywords: Aortic Diseases, Ischemic Attack, Transient, Paresis, Aged, Aneurysm, Dissecting, computed tomography angiography, Fatal Outcome, Missed Diagnosis, Peripheral Nervous System Diseases

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923