Right Lower Extremity Numbness- an Atypical Presentation of Acute Aortic Dissection
Abstract
Acute aortic dissection (AAD) is one of the most challenging and emergency conditions in the health care system. It`s associated with high mortality. A 55-year-old person was admitted to the emergency department due to numbness of his right leg. The patient had no complaints of chest pain on arrival. However, echocardiography revealed aortic dissection and computed tomography (CT) scan confirmed the diagnosis. The patient was immediately referred to Rajaei hospital for further specialized procedures. He went into the operating room directly and had a successful operation of aortic dissection repair. Rarely AAD has atypical manifestation and may have unusual clinical presentations. Thus, it could cause a delay in establishment of diagnosis of this emergent condition. The purpose of this report was to introduce a rare initial presentation of an atypical aortic dissection.
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[2] Daily PO. Management of acute aortic dissections. Ann Thorac Surg. 1970; 10:237-47.
[3] SPITTELL PC, SPITTELL Jr JA, JOYCE JW, Tajik AJ, EDWARDS WD, SCHAFF HV, et al., editors. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clinic Proceedings; 1993: Elsevier.
[4] Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. 2015;66(4):350-8.
[5] Imamura H, Sekiguchi Y, Iwashita T, Dohgomori H, Mochizuki K, Aizawa K, et al. Painless Acute Aortic Dissection–Diagnostic, Prognostic and Clinical Implications–. Circulation Journal. 2011;75(1):59-66.
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[8] Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. Jama. 2000;283(7):897-903.
[9] Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. The American journal of cardiology. 1984;53(6):849-55.
[10] Mehta RH, O’Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. Journal of the American College of Cardiology. 2002;40(4):685-92.
[11] Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II:
therapeutic management and follow-up. Circulation. 2003;108(6):772-8.
[12]Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):1271-8.
[13] Landenhed M, Engström G, Gottsäter A, Caulfield MP, Hedblad B, Newton-Cheh C, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. Journal of the American Heart Association. 2015;4(1):e001513.
[14] Alter SM, Eskin B, Allegra JR. Diagnosis of aortic dissection in emergency department patients is rare. Western Journal of Emergency Medicine. 2015;16(5):629.
[15] Gerber O, Heyer EJ, Vieux U. Painless dissections of the aorta presenting as acute neurologic syndromes.
Stroke. 1986;17(4):644-7
[16] Brennan KB, Aggarwal S, Szeto WY, Augoustides JG, Cheung AT, editors. Blood pressure and antihypertensive therapy predict outcomes in acute aortic dissection. Anesthesiology annual meeting: American Society of Anesthesiologists; 2009.
[17]. Cheung AT, Aggarwal S, Augoustides JG, Szeto WY, Brennan KB. Perioperative renal failure predicts outcome in stanford type A aortic dissection. Risk. 1992;12(13):5.
[18] Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic
aortic dissection by noninvasive imaging procedures. New England Journal of Medicine. 1993;328(1):1-9.
[19] Wilbourn AJ, Furlan AJ, Hulley W, Ruschhaupt W. Ischemic rnonornelic neuropathy. Neurology. 1983;33(4):447-.
[20] WEISMAN AD, ADAMS RD. The neurological complications of dissecting aortic aneurysm. Brain. 1944;67(2):69-92.
[2] Daily PO. Management of acute aortic dissections. Ann Thorac Surg. 1970; 10:237-47.
[3] SPITTELL PC, SPITTELL Jr JA, JOYCE JW, Tajik AJ, EDWARDS WD, SCHAFF HV, et al., editors. Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990). Mayo Clinic Proceedings; 1993: Elsevier.
[4] Pape LA, Awais M, Woznicki EM, Suzuki T, Trimarchi S, Evangelista A, et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology. 2015;66(4):350-8.
[5] Imamura H, Sekiguchi Y, Iwashita T, Dohgomori H, Mochizuki K, Aizawa K, et al. Painless Acute Aortic Dissection–Diagnostic, Prognostic and Clinical Implications–. Circulation Journal. 2011;75(1):59-66.
[6] Bedanie G, Abaleka FI, Tikue A, Thongtan T, Ansari MM. Atypical Presentation of Fatal Disease: Painless Aortic Dissection. Cureus. 2021;13(4).
[7] Crawford ES. The diagnosis and management of aortic dissection. Jama. 1990;264(19):2537-41.
[8] Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. Jama. 2000;283(7):897-903.
[9] Larson EW, Edwards WD. Risk factors for aortic dissection: a necropsy study of 161 cases. The American journal of cardiology. 1984;53(6):849-55.
[10] Mehta RH, O’Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, et al. Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. Journal of the American College of Cardiology. 2002;40(4):685-92.
[11] Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: Part II:
therapeutic management and follow-up. Circulation. 2003;108(6):772-8.
[12]Meszaros I, Morocz J, Szlavi J, Schmidt J, Tornoci L, Nagy L, et al. Epidemiology and clinicopathology of aortic dissection. Chest. 2000;117(5):1271-8.
[13] Landenhed M, Engström G, Gottsäter A, Caulfield MP, Hedblad B, Newton-Cheh C, et al. Risk profiles for aortic dissection and ruptured or surgically treated aneurysms: a prospective cohort study. Journal of the American Heart Association. 2015;4(1):e001513.
[14] Alter SM, Eskin B, Allegra JR. Diagnosis of aortic dissection in emergency department patients is rare. Western Journal of Emergency Medicine. 2015;16(5):629.
[15] Gerber O, Heyer EJ, Vieux U. Painless dissections of the aorta presenting as acute neurologic syndromes.
Stroke. 1986;17(4):644-7
[16] Brennan KB, Aggarwal S, Szeto WY, Augoustides JG, Cheung AT, editors. Blood pressure and antihypertensive therapy predict outcomes in acute aortic dissection. Anesthesiology annual meeting: American Society of Anesthesiologists; 2009.
[17]. Cheung AT, Aggarwal S, Augoustides JG, Szeto WY, Brennan KB. Perioperative renal failure predicts outcome in stanford type A aortic dissection. Risk. 1992;12(13):5.
[18] Nienaber CA, von Kodolitsch Y, Nicolas V, Siglow V, Piepho A, Brockhoff C, et al. The diagnosis of thoracic
aortic dissection by noninvasive imaging procedures. New England Journal of Medicine. 1993;328(1):1-9.
[19] Wilbourn AJ, Furlan AJ, Hulley W, Ruschhaupt W. Ischemic rnonornelic neuropathy. Neurology. 1983;33(4):447-.
[20] WEISMAN AD, ADAMS RD. The neurological complications of dissecting aortic aneurysm. Brain. 1944;67(2):69-92.
| Files | ||
| Issue | Vol 8 No 1 (2023): Janyary-February | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v8i1.13095 | |
| Keywords | ||
| Aortic Dissection Acute Aortic Dissection AAD Emergency Medicine Numbness Lower Extremity Numbness | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Masoumi Z, Alavi SM, Sedaqat M, Shahidi M. Right Lower Extremity Numbness- an Atypical Presentation of Acute Aortic Dissection. CRCP. 2023;8(1):24-28.
