title: Seizure as initial manifestation of aortic dissection type a.
abstract: BACKGROUND
  Seizure as the initial manifestation of aortic dissection is rare.
  
  
  METHODS
  An 88-year-old female experienced a first generalized tonic clonic seizure, which was terminated with midazolam. Acute cerebral magnetic resonance imaging and angiography were non-informative. After awaking she complained about cramping pain in the right upper extremity, which was accompanied by involuntary flexion movements of the right upper extremity. Blood pressure was initially normal. Blood gases revealed metabolic acidosis and blood chemical investigations a markedly increased D-dimer. Consecutively blood pressure declined and transthoracic echocardiography showed pericardial effusion. A computed tomography scan of the thorax revealed an aortic dissection type A. The patient died 16 hours after admission after cardiothoracic surgeons had refused surgical treatment.
  
  
  CONCLUSIONS
  This case shows that a generalized tonic-clonic seizure may be the initial manifestation of an aortic dissection type A in the absence of thoracic chest pain and that brachyalgia may not develop earlier than with progression of the dissection.
authors.affiliation: Vienna, Austria, Europe.
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
authors.forename: Marlies
authors.initials: M
authors.lastname: Frank
authors.forename: Hans
authors.initials: H
authors.lastname: Keller
authors.forename: Adam
authors.initials: A
authors.lastname: Bastowanski