Aortic Dissection with Haemothorax Mimicking a Stroke

Aortic dissection is a life-threatening clinical emergency and a challenging diagnosis. Depending on its initial location, it may present with several symptoms with the most common being chest pain. We describe the case of a 62-year-old man admitted to the Emergency Department with acute neurological deficits and triaged for the stroke protocol. After unexpected findings on physical examination, other diagnostic hypotheses were evaluated, culminating in the diagnosis of aortic dissection with haemothorax mimicking a stroke. LEARNING POINTS: Aortic dissection is a clinical emergency with a high rate of misdiagnosis; it may present with unusual symptoms depending on its initial location. Stroke mimics are diverse non-vascular conditions that can present with acute neurological deficits simulating an acute stroke, some of which are contraindications for thrombolytic treatment. An accurate initial physical examination in the emergency department is crucial so less common conditions can be evaluated and fatal thrombolytic treatment avoided.