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Case Reports
. 2008;35(3):359-61.

Silent aortic dissection presenting as transient locked-in syndrome

Wadih Nadour  1 , Brian Goldwasser, Robert W Biederman, Kevin Taffe
Affiliations
Case Reports

Silent aortic dissection presenting as transient locked-in syndrome

Wadih Nadour et al. Tex Heart Inst J. 2008.

Abstract

Acute aortic dissection is a medical emergency. Without prompt recognition and treatment, the mortality rate is high. An atypical presentation makes timely diagnosis difficult, especially if the patient is experiencing no characteristic pain. Many patients with aortic dissection are reported to have presented with various neurologic manifestations, but none with only a presentation of transient locked-in syndrome.Herein, we report a case of completely painless aortic dissection in a woman who presented with a transient episode of anarthria, quadriplegia, and preserved consciousness. On physical examination, she had a 40-point difference in blood pressure between her left and right arms, and a loud diastolic murmur. The diagnosis of acute aortic dissection was reached via a combination of radiography, computed tomography, echocardiography, and a high index of clinical suspicion. The patient underwent emergency surgery and ultimately experienced a successful outcome.To our knowledge, this is the 1st report of aortic dissection that presented solely as locked-in syndrome. We suggest that silent aortic dissection be added to the differential diagnosis for transient locked-in syndrome.

Keywords: Akinetic mutism/diagnosis/etiology; aneurysm, dissecting/diagnosis; aortic aneurysm/diagnosis; consciousness; quadriplegia/diagnosis/etiology/physiopathology; time factors.

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Figures

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Fig. 1 Chest radiograph shows a wide mediastinum, the absence of pleural or pericardial effusion, and normal lung fields.
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Fig. 2 Noncontrast computed tomography of the chest shows massive dilation of the ascending aorta (diameter, 6.8 cm).
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Fig. 4 Transesophageal echocardiography, short-axis view, shows the proximal aorta, with a complete intimal flap. The long arrow shows the false lumen; the short arrow shows the true lumen. Real-time motion image is available at texasheart.org/journal.
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Fig. 3 Transesophageal echocardiography, long-axis view, shows aortic regurgitation. The aortic root and proximal arch form a central flap that arises from the sinotubular junction, with preservation of the sinus of Valsalva but with distortion of the valvular geometry. The white arrow shows the true lumen; the black arrow shows the false lumen. Real-time motion image is available at texasheart.org/journal.
See this image and copyright information in PMC

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