Bekele Ebisa, Kagolanu Deepthi Chaitanya, Kim Martin, Stephenson Kent
Nassau University Medical Center, East Meadow, New York, USA.
BMJ Case Rep. 2017 Mar 24;2017:bcr2016218432. doi: 10.1136/bcr-2016-218432.
Acute aortic dissection is associated with significant morbidity and mortality, often from complications including aortic regurgitation, cardiac tamponade and myocardial infarction. Typical clinical presentation includes a sudden onset of severe chest pain, although this is not always consistent. Clinical signs and symptoms are diverse with an estimated 38% of cases being missed on initial evaluation. Primary neurological symptoms at presentation are rare but have been reported often to coexist with chest pain. We present a case of acute aortic dissection in which the initial presenting symptoms were predominantly neurological. Stanford type A dissection is a surgical emergency with a high burden of cardiovascular death; thus, aggressive identification and management is paramount. Our case re-emphasises the importance of having a higher index of suspicion and a keen clinical eye for atypical presentations of acute aortic dissection.
急性主动脉夹层与显著的发病率和死亡率相关，通常源于包括主动脉瓣反流、心脏压塞和心肌梗死等并发症。典型的临床表现包括突发的严重胸痛，尽管情况并非总是如此。临床体征和症状多种多样，据估计，初始评估时有38%的病例被漏诊。就诊时出现原发性神经症状的情况很少见，但经常有报道称其与胸痛并存。我们报告一例急性主动脉夹层病例，其最初的症状主要是神经症状。斯坦福A型夹层是一种外科急症，心血管死亡负担很高；因此，积极的识别和处理至关重要。我们的病例再次强调了对急性主动脉夹层非典型表现保持更高怀疑指数和敏锐临床眼光的重要性。
