AORTIC DISSECTION: OFTEN NEGLECTED DIFFERENTIAL DIAGNOSIS IN EMERGENCY AMBULANCE SERVICES

Abstract

Introduction: Aortic dissection is a rupture of the aortal medial layer produced by intramural hemorrhage that leads in a separation of the aortic wall layers, forming a false and true lumen with or without communication and is highly lethal. It causes a variety of symptoms, which can be discrete and subacute, or chronic, and is frequently misdiagnosed. Aim: This case report aims to present a case of a rare, subtle manifestation of transient ischemic attack caused by an aortic dissection. Case report: A 76-year-old man came to the Emergency Medical Service complaining of recent back and left shoulder pain accompanied by discomfort, as well as left-sided tingling of the face, arm, and leg, along with left hand weakness, that had occurred multiple times in the previous five days and lasted three to four minutes. On admission, he was clinically stable and had normal vital signs, without any neurological deficit. The ECG examination revealed RBBB without ST segment abnormalities. The anamnestic and hetero-anamnestic data were completely consistent with a cerebrovascular transient ischemic attack that occurred three days prior. After reevaluating the patient clinical status that was unchanged, he experienced temporary weakness, sweating, and dizziness revealed by shifting from supine to straight position, which was instantly relieved by kneeling down on the floor. The patient was immediately referred to secondary care. While a CT of the brain revealed normal findings, the CT angiography of the aorta showed an infrarenal aneurismatic dilatation with a 4cm wide flap indicative of impending aortal dissection. The patient was promptly referred to a tertiary care for further examination and medical care. Conclusion: Aortal dissection can easily go undetected in the Emergency Medical Services due to its pleomorphic clinical presentation, which oscillates between acute hemodynamic shocks to subtle, often undetectable symptomatology. Awareness of aortic dissection as differential diagnosis should be promptly lifted to a higher order thinking.