Painless Aortic Dissection Presented with Ischemic Stroke and Developed Congestive Heart Failure: A Case Report

Abstract

Aortic dissection (AD) is a life-threatening condition that presents with diverse and atypical symptoms. Although transient or permanent neurological symptoms at onset of aortic dissection are not frequent (17-40% of the patients), a diagnosis with predominant neurological symptoms can be difficult and delayed especially in pain-free dissection (which occur in 5-15%). Additionally, only 6% of aortic dissections present with acute congestive cardiac failure, recognized as a potential complication of aortic dissection.  We reported the case of 53-year-old female who presented with left-side weakness and numbness without chest pain. After 5 days of admission, she developed atrial fibrillation, congestive heart failure and respiratory failure. Transthoracic echocardiography (TTE) revealed dilated ascending aorta, dissection flap at the ascending aorta extended to descending aorta with hemopericardium. She received a delayed diagnosis of type A aortic dissection. Aortic dissection should always be included in the differential diagnosis of ischemic stroke and unexplained acute congestive heart failure, regardless of the presence of chest pain.