title: A patient with altered mental status and possible seizure reveals an atypical aortic dissection upon workup.
abstract: Aortic dissection occurs when a tear occurs in the inner muscle wall lining of the aorta, allowing blood to split the muscle layers of the aortic wall apart. It is classically characterized by pain that starts in the upper chest, which then radiates to the upper back and is tearing or ripping in quality. Our objective is to present a case followed by a brief literature review of aortic dissection and uncommon but important features that may be demonstrated. In this report, we present the case of a 57-year-old woman who was transported to the emergency department with an acute episode of altered mental status, presenting as a possible stroke with possible seizures. The patient's only complaint was mild low back pain. Physical examination revealed disorientation to time with no other neurologic deficits or abnormal findings. Results from initial noncontrast head computed tomography, chest radiograph, and laboratory studies were all normal, except for an elevated D-dimer and serum creatinine. Chest computed tomography with contrast demonstrated a type A aortic dissection. The patient was taken emergently to the operating room where the aortic valve and a portion of the ascending aorta were replaced. The patient did well and was discharged from the hospital 5 days later without any permanent sequalae. Aortic dissection is both rare and life threatening and may present with atypical signs. It is important to note that patients may show no signs of typical features or may even display other symptoms based on other branches from the aorta that have been occluded.
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Health Systems, Richmond, VA.
authors.forename: Olufolahan J
authors.initials: OJ
authors.lastname: Lawal
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Health Systems, Richmond, VA.
authors.forename: Harinder S
authors.initials: HS
authors.lastname: Dhindsa
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Health Systems, Richmond, VA. Electronic address: loydjw@vcu.edu.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Loyd
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis* / Q000601:surgery; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000601:surgery; D003221:Confusion; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis; D014057:Tomography, X-Ray Computed