title: Painless acute aortic dissection. - Diagnostic, prognostic and clinical implications.-.
abstract: BACKGROUND
  Acute aortic dissection (AAD) classically presents as sudden, severe chest, back, or abdominal pain. However, there have been several documented cases presenting with atypical features. The clinical characteristics and outcomes of patients with painless AAD were investigated.
  
  
  RESULTS
  The study group comprised 98 patients (53 males, 45 females; 66 ± 12 years) with AAD admitted to hospital from 2002 to 2007: 16 patients (17%) had no pain (painless group) and 82 patients had pain (painful group). In 81% of the painless group and 70% of the painful group there was a type A dissection. The painless group more frequently had a persistent disturbance of consciousness (44% vs. 6%, P < 0.001), syncope (25% vs. 1%, P < 0.001) and a focal neurologic deficit (19% vs. 2%, P = 0.006) as presenting symptoms. Imaging study findings were not significantly different. Cerebral ischemia (50% vs. 1%, P < 0.001) and cardiac tamponade (38% vs. 13%, P = 0.01) were more frequent complications in the painless group. In-hospital mortality was not significantly different (19% vs. 15%). However, the painless group had a more unfavorable functional outcome on overall performance category (P < 0.001).
  
  
  CONCLUSIONS
  Painless AAD may be more frequent than previously reported. Painless AAD patients often present with a disturbance of consciousness or a neurologic deficit, and have a higher morbidity than painful AAD patients.
authors.affiliation: Department of Emergency and Intensive Care Medicine, Shinshu University School of Medicine, Matsumoto, Japan. imamura@shinshu-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Iwashita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Dohgomori
authors.forename: Katsunori
authors.initials: K
authors.lastname: Mochizuki
authors.forename: Kazunori
authors.initials: K
authors.lastname: Aizawa
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Aso
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kamiyoshi
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
authors.forename: Jun
authors.initials: J
authors.lastname: Amano
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Okamoto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D058070:Asymptomatic Diseases; D002545:Brain Ischemia / Q000209:etiology; D002305:Cardiac Tamponade / Q000209:etiology; D003244:Consciousness Disorders / Q000209:etiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010146:Pain / Q000209:etiology*; D012189:Retrospective Studies; D013575:Syncope / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome