Acute liver failure and seizure: a case report of an unusual presentation of acute painless aortic dissection

Abstract

Background Painless aortic dissection presenting with seizure and acute liver failure is uncommon. We described a case of early recognition leading to successful treatment of painless aortic dissection with atypical presentation. Case summary A young lady presented with generalized tonic-clonic seizures coupled with hepatitic pattern of deranged liver function test. Examination revealed blood pressure of 99/75 mmHg and hepatic flap. Electrocardiography showed sinus tachycardia. Urgent bedside echocardiography showed preserved cardiac function without significant valvular pathology, but noted a moderate pericardial effusion. Abdominal Ultrasound excluded liver cirrhosis or biliary obstructions. Viral hepatitis serologies and anti-liver panel were negative. She was progressively hypotensive with concurrent acute liver failure and oliguric acute kidney injury. Despite no chest pain, her rising serum troponin and widened mediastinum prompted an urgent computed-tomography aortogram, which showed a 4.3 cm dilatation of ascending thoracic aorta with acute haemopericardium and cardiac tamponade. She was diagnosed with malperfusion syndrome from Stanford type A aortic dissection. She underwent emergent ascending aorta and aortic arch repair and dialysis. She experienced complete recovery in her kidney, liver, and neurological function post-operatively. Discussion Painless aortic dissection masquerade as acute liver failure is uncommon. We describe a successful early recognition of malperfusion syndrome from painless aortic dissection, thus providing window for timely, life-saving intervention. Clinical challenges in this case include: (i) atypical presentation of aortic dissection, (ii) worsening acute liver failure which could lead to unnecessary liver transplantation, and (iii) risk of contrast-induced nephropathy in the setting of acute renal failure.

Seizure and bilateral external jugular vein distention: a rare manifestation of Stanford type A aortic dissection

“…AAD is considered a medical emergency with high rates of mortality and morbidity [1] . The incidence of AAD in temperature 36.8 °C, and O 2 saturation 98% with Fio 2 0.60.…”

“…AAD is considered a medical emergency with high rates of mortality and morbidity [ 1 ] . The incidence of AAD in the general population ranges between 4 and 6 cases per 100,000 persons per year.…”

“…Multiple factors contribute to AAD, arterial hypertension and known connective tissue disease being the most common risk factors. The most frequent presentation is sudden-onset severe chest or back pain [ 1 ] . Usually, the pain is described as tearing or ripping by patients who survive the life-threatening condition [ 3 ] .…”

Ultrasound Combined with CTA in Diagnosis of Painless Aortic Dissection Combined with Carotid Artery Active Thrombosis: A Case Report

“…This disease typically presents with a sudden onset and rapid progression, with approximately 90% of patients experiencing acute or persistent chest or back pain characterized by a tearing or cutting sensation [2]. Although abrupt onset thoracic pain is one of the most common symptoms in acute aortic dissection, there are still around 6.4% of painless aortic dissection patients [3]. The mechanism of painless aortic dissection remains incompletely clear.…”