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Case Reports
. 2015 Feb 15;8(2):3020-3.
eCollection 2015.

Unexpected cause of a right hemiplegia secondary to the painless full-length aortic dissection: a case report and literature review

Shu Huang  1 , Jialan Sun  1 , Longxuan Li  1
Affiliations
Case Reports

Unexpected cause of a right hemiplegia secondary to the painless full-length aortic dissection: a case report and literature review

Shu Huang et al. Int J Clin Exp Med. .

Abstract

Painless aortic dissections in general are uncommon and are frequently misdiagnosed. Here we reported a rare case of acute ischemic stroke secondary to completely painless acute full-length dissection (DeBakey I) and provide a brief review of the literature. A 56-year-old man was referred to our department with right hemiplegia. Ischaemic stroke and thrombolytic treatment were considered initially. At the second examination, the patient was found to have decreased blood pressure, asymmetrical blood pressure/pulses between the bilateral limbs, and sudden loss of pulse in a lower extremity. Laboratory results revealed leucocytosis, elevated creatinine and CK without obvious cause. An aortic dissection was subsequently confirmed by contrast enhanced thoracic and abdominal CT scan. Our report provides some clues for the early diagnosis of painless aortic dissections.

Keywords: Completely painless acute aortic dissection; asymmetrical pulses; blood pressure; ischemic stroke.

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Figures

Figure 1
Figure 1
A painless full-length aortic dissection presenting with acute ischemic stroke. T2-weighted MRI images demonstrate a bright signal lesion (white arrowhead) in the right basilar part of pons (A) and a small slightly high signal lesion (white arrowhead) in corona radiate (B), MRI-DWI shows no new lesions in the corresponding regions (C, D), MRA displays non visualization of the left internal carotid artery and middle cerebral artery (MCA) and its branches become slender (E). Contrast enhanced thoracic and abdominal CT scans reveal dissection within the root of the ascending aorta (black arrow) (F), with supra-aortic branches (black arrow) (G), aortic arch (black arrow) (H), thoracic ascending and descending aorta (I), superior mesenteric artery (black arrow) (J) and abdominal aorta up to left common iliac artery (white arrow) (K). Three-dimensional volume rendering view illustrating the extent of aortic dissection (L).
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