Type A Aortic Dissection Presenting with Neurological Symptoms Mimicking Stroke and Intracranial Hemorrhage

Acute aortic dissection is a rare but lethal cardiac disease involving the aorta, which presents with typical symptoms, including severe, sharp, or tearing acute onset of chest or back pain. Other unspecific symptoms, such as epigastric pain, nausea, and vomiting, may be also present. Neurologic symptoms induced by aortic dissection are also present in rare cases but often lead to delate diagnosis because they mimic stroke and intracranial hemorrhage. Therefore, it is important to understand acute aortic dissection-induced neurologic symptoms. Here, we present a case of a 60-year-old male who presented with an acute onset of progressive flaccid hemiplegia on the left side accompanied with slurred speech. Brain computed tomography showed widening of the cortical sulci and dilatation of the ventricles, without intracranial hemorrhage. When waiting for thrombolysis or thrombectomy intervention, acute chest pain was noted. After management, type A dissection from ascending aorta with extension to the right external iliac artery was noted in computed tomography angiography, which also involved the brachiocephalic trunk, left common carotid artery, celiac trunk, superior mesenteric artery, and right renal artery. This paper describes the clinical features of type A dissection, especially the neurological symptoms, and highlights the importance of early diagnosis and timely intervention for type A dissection patients.