Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19102, USA.
Am J Emerg Med. 2013 Jan;31(1):269.e1-2. doi: 10.1016/j.ajem.2012.04.029. Epub 2012 Jun 27.
Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55-year-old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head computed tomography demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest x-ray should always be obtained before administering thrombolytics.
传统的急诊医学教条认为，主动脉夹层表现为撕裂样胸痛，并放射至背部。本病例报告描述了一位 55 岁女性，表现为左侧同向性偏盲和步态障碍。初始头部计算机断层扫描显示右侧顶叶梗死，胸部 X 线片显示明显增宽的纵隔。随后证实为急性斯坦福 A 型主动脉夹层。本报告进一步提供了主动脉夹层非典型、无痛表现的证据。鉴于最近关于无痛性夹层发病率增加的文献，应将该疾病实体纳入中风的鉴别诊断中，并且在给予溶栓药物之前，应始终进行简单的便携式胸部 X 光检查。
