Key result
A 58-year-old female with painless type A aortic dissection presented with atrial fibrillation and acute ischemic stroke, ultimately dying 4 hours after symptom onset.
Case Report (n=1)
Painless type A aortic dissection can present with acute ischemic stroke and atrial fibrillation with ischemic ECG changes, requiring high clinical suspicion and appropriate imaging.
May warrant considering aortic dissection in AF with stroke; single case leaves open prevalence and screening implications.
Aortic dissection is diagnostically challenging, especially in pain-free patients. Detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians and neurologists. We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. Perfusion CT-imaging showed a dilatation of the aortic arch and intraluminal structures indicating an intima flap of aortic dissection. Four hours after onset of symptoms the patient died on the way to the cardiac surgery. In conclusion, apart from imaging the aortic arch by computed tomography in acute stroke patients, the electrocardiogram may be indicative for aortic dissection if it shows signs for myocardial ischemia in previously healthy patients.
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Stöllberger et al. (2017) conducted a case report in Painless type A aortic dissection (n=1). A 58-year-old female with painless type A aortic dissection presented with atrial fibrillation and acute ischemic stroke, ultimately dying 4 hours after symptom onset.
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