Painless acute aortic dissection with a left hemiparesis

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.