Clinical features of type A aortic dissection initially presenting with neurological symptoms: a single-center case series

Background Aortic dissection, a life-threatening condition, may present with neurological symptoms mimicking acute stroke, leading to delayed diagnosis and inappropriate management. Objective To describe the clinical characteristics and outcomes of patients with type A aortic dissection (TAAD) who initially presented with neurological symptoms and were first admitted to the neurology department. Methods We retrospectively reviewed the demographic, clinical, laboratory, imaging, treatment and outcome data of 23 patients with TAAD who initially presented with neurological symptoms and were first admitted to our neurology department between October 2019 and August 2025 and were subsequently confirmed to have TAAD. Results The mean age of patients was 62.4 ± 12.2 years, and eight (34.8%) were women. The most common presenting symptoms were altered consciousness (15 cases, 65.2%) and limb weakness (13 cases, 56.5%), including 11 cases of left-sided weakness; only five patients (21.7%) reported chest or back pain. The median D-dimer level was 22.73 mg/L (interquartile range [IQR], 9.13–61.17). Nine patients (39.1%) received intravenous thrombolysis before the diagnosis of acute aortic dissection, and four (17.4%) underwent surgical repair. Fifteen patients (65.2%) died during hospitalization, and eight (34.8%) were discharged alive. Discharged patients were followed up for a median of 39 months (IQR, 14–57.75), during which two surgically treated patients remained alive, while four of the six non-surgically treated patients died. The overall long-term survival rate was 17.4% (4/23). Conclusion Acute TAAD may mimic acute stroke, leading to misdiagnosis and inappropriate thrombolytic therapy. In patients without typical chest pain, atypical features such as altered consciousness, left-sided weakness, elevated D-dimer levels, and an inter-arm blood pressure difference, when present, may raise suspicion for TAAD.