Vienna, Austria, Europe.
West J Emerg Med. 2010 Dec;11(5):510-1.
Seizure as the initial manifestation of aortic dissection is rare.
An 88-year-old female experienced a first generalized tonic clonic seizure, which was terminated with midazolam. Acute cerebral magnetic resonance imaging and angiography were non-informative. After awaking she complained about cramping pain in the right upper extremity, which was accompanied by involuntary flexion movements of the right upper extremity. Blood pressure was initially normal. Blood gases revealed metabolic acidosis and blood chemical investigations a markedly increased D-dimer. Consecutively blood pressure declined and transthoracic echocardiography showed pericardial effusion. A computed tomography scan of the thorax revealed an aortic dissection type A. The patient died 16 hours after admission after cardiothoracic surgeons had refused surgical treatment.
This case shows that a generalized tonic-clonic seizure may be the initial manifestation of an aortic dissection type A in the absence of thoracic chest pain and that brachyalgia may not develop earlier than with progression of the dissection.
以癫痫发作为首发表现的主动脉夹层少见。
一位 88 岁女性首次出现全面强直阵挛性发作，用咪达唑仑终止。急性脑磁共振成像和血管造影均无信息。苏醒后她诉右上肢痉挛性疼痛，伴有右上肢不自主弯曲运动。血压最初正常。血气分析提示代谢性酸中毒，血液化学检查发现 D-二聚体显著升高。随后血压下降，经胸超声心动图显示心包积液。胸部计算机断层扫描显示主动脉夹层 A 型。心胸外科医生拒绝手术治疗后，患者在入院后 16 小时死亡。
本例表明，在无胸痛的情况下，全面强直阵挛性发作可能是 A 型主动脉夹层的首发表现，且臂痛可能不会早于夹层进展出现。
