Highlights that ischemic stroke can be the first presentation of aortic dissection, which may occur without typical pain.
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Stroke as initial sign of painless aortic dissection warrants targeted aortic imaging; leaves open validation in larger cohorts.
Brain stroke connected with aortic blood flow disturbances is a rare disease and its incidence is difficult to assume. Nevertheless, 10-50% of patients with aortic dissection may not experience any pain. In case of 18-30% patients with aortic dissection neurological signs are first disease presentation and among them ischemic stroke is the most common. The most popular aortic dissection classification is with use of Stanford system. Type A involves the ascending aorta and type B is occurring distal to the subclavian artery. Aortic dissection risk factors include hypertension, cystic medionecrosis, bicuspid aortic valve and Marfan's or Ehlers-Danlos syndrome.
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Pastuszak et al. (2017) studied this question.
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