IMAGES IN EMERGENCY MEDICINE
Painless acute aortic dissection, not brain infarction
Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
Correspondence to:
Dr S Inoue, Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Bouseidai, Isehara, Kanagawa 259-1143, Japan; sg-inoue@is.icc.u-tokai.ac.jp
Accepted 30 May 2008
| The first 150 words of the full text of this article appear below. |
A 72-year-old woman presented with consciousness disturbance and left hemiparesis. Computed tomography of the head was normal and diffusion-weighted magnetic resonance imaging did not demonstrate the high-intensity signals suggestive of brain infarction. A three-dimensional magnetic resonance angiogram of the brain vessels revealed diffuse right-sided cerebral hypoperfusion without occlusion (fig 1). Although she experienced no chest or back pain, the chest radiography showed superior mediastinal widening. Contrast computed tomography of the chest demonstrated aortic dissection (DeBakey type I, Stanford type A) with a false lumen in the innominate artery without complete occlusion (fig 2). She was observed conservatively. Her left hemiparesis gradually improved and she was discharged.
Figure 1 Three-dimensional magnetic resonance angiogram of the brain vessels demonstrating diffuse right-sided cerebral hypoperfusion without occlusion.
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Figure 2 Contrast computed tomography of the chest reveals type A aortic dissection.
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Acute aortic dissection is difficult to diagnose when the presenting symptoms and signs are
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