Painless aortic dissection with catastrophic consequences presenting as sudden loss of consciousness with no prodromal symptoms
  • Yasaman Navari
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, USA
  • Ajit Brar
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, USA
  • Bibek Karki
    Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, Michigan, USA; Department of Public Health, State University of New York, Albany, New York, USA
  • Samir Elian
    Department of Internal Medicine, Division of Cardiology, Michigan State University at Hurley Medical Center, Flint, Michigan, USA

Keywords

Type A aortic dissection, Bentall procedure, atypical symptoms

Abstract

This case report presents a complex clinical scenario involving a 71-year-old female with aortic dissection accompanied by hypotension. The patient’s initial presentation of sudden loss of consciousness unveiled a large pericardial effusion and cardiac tamponade, leading to emergency surgery. Subsequent diagnostic findings revealed an intramural haematoma with an intimal tear in the ascending aorta. Postoperatively, the patient experienced an ischaemic stroke, necessitating prompt neurology consultation and treatment. This report underscores the significance of early recognition and collaborative management in achieving positive patient outcomes.

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References

  • Pedersen MW, Kragholm K, Oksjoki R, Moller JE, Gundlund A, Fosbol E, et al. Characteristics and outcomes in patients with acute aortic dissection: a nationwide registry study. Ann Thorac Surg 2023;S0003-4975(23)00683-5.
  • Wang MM, Gai MT, Wang BZ, Maituxun M, Yesitayi G, Chen BD, et al. The diagnostic and prognostic value of SAA1 as a novel biomarker for acute aortic dissection. J Proteomics 2023;104958.
  • Rivera JA, Aragon D, Thomas P, Dominici P, Menowsky M, Akala OO. RUSHing to the diagnosis: aortic abdominal aneurysm detected using the rapid ultrasound for shock and hypotension (RUSH) protocol in the wards. Cureus 2022;14:e32565.
  • Fatima S, Sharma K. Painless aortic dissection – diagnostic dilemma with fatal outcomes: what do we learn? J Investig Med High Impact Case Rep 2017;5:2324709617721252.
  • Natour AK, Rteil A, Shepard A, Weaver M, Nypaver T, Nemeh H, et al. Outcomes of patients with acute type A aortic dissection and concomitant lower extremity malperfusion. J Vasc Surg 2022;76:631–638.
  • Lasica RM, Perunicic JP, Popovic DR, Mrdovic IB, Arena RA, Radovanovic NL, et al. Early and late mortality predictors in patients with acute aortic dissection type B. Cardiol Res Pract 2022;2022:7869356.
  • Ayrik C, Cece H, Aslan O, Karcioglu O, Yilmaz E. Seeing the invisible: painless aortic dissection in the emergency setting. Emerg Med J 2006;23:e24.
  • Guo R, Feng YM, Wan D. Hemorrhagic cardiac tamponade complicated by acute type A aortic dissection: a case report with critical care ultrasound findings. Medicine (Baltimore) 2017;96:e8773.
  • Isselbacher EM, Cigarroa JE, Eagle KA. Cardiac tamponade complicating proximal aortic dissection. Is pericardiocentesis harmful? Circulation 1994;90:2375–2378.
  • Apaydin AZ, Buket S, Posacioglu H, Islamoglu F, Calkavur T, Yagdi T, et al. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Ann Thorac Surg 2002;74:2034–2039.
  • Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, et al. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg 2007;83:55–61.
  • Lin CY, Lee CY, Lee HF, Wu MY, Tseng CN, Tsai FC,et al. Postoperative stroke after type A aortic dissection repair: hemorrhage versus ischemia. World J Surg 2022;46:690–700.

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    Published: 2023-09-21
    Issue: 2023: Vol 10 No 11 (view)

    How to cite:
    1.
    Navari Y, Brar A, Karki B, Elian S. Painless aortic dissection with catastrophic consequences presenting as sudden loss of consciousness with no prodromal symptoms. EJCRIM 2023;10 doi:10.12890/2023_004081.

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