2 cases of cerebral ischemic attack caused by painless acute aortic dissection

Abstract

Differentiating acute aortic dissection that develops cerebral ischemic symptoms in stroke practice is very important for avoiding inappropriate IV rt-PA therapy beyond delaying treatment of acute aortic dissection. Although acute aortic dissection with cerebral ischemic symptoms is infrequent, it may exist in patients who are suspected of stroke with neurological symptoms such as unconsciousness and aphasia. Acute aortic dissection can be non-specific and may depend on various symptoms such as where the tear is located in the aorta. In order to not miss out acute aortic dissection that develops with cerebral ischemic symptoms without chest and back pain, it is necessary to understand the clinical findings of acute aortic dissection such as low blood pressure, difference of right and left blood pressure, mediastinal widening on chest X-ray, and high D-dimer. In an auxiliary imaging operation, cervical MRA is useful not only for the evaluation of pathophysiology of cerebral infarction but also to diagnose acute aortic dissection. We report two cases of acute thoracic aortic dissection that developed with cerebral ischemic symptoms without chest pain along with a literature review.