Aortic Dissection: An Easily Missed Diagnosis when Pain Doesn’t Hold the Stage

Case series Patients: Male, 73-year-old • Female, 70-year-old Final Diagnosis: Aortic dissection Symptoms: Paresis Medication: — Clinical Procedure: — Specialty: Neurology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Type A aortic dissection (AD) is a rare disease, with a high mortality rate. Its most common symptom is thoracic pain, which is nevertheless absent in about 6% of cases. Neurologic complications are extremely rare and include ischemic stroke and ischemic neuropathy (which are the most common as presenting symptoms), spinal cord ischemia, and hypoxic encephalopathy. These rare neurological presentations can often be missed at initial clinical examination. CASE REPORT: We report 2 cases of patients presenting with seemingly mild neurological symptoms. However, diagnostic tests revealed acute type A AD, and further steps were taken. CONCLUSIONS: Although it is a rare cause of transient stroke or peripheral nerve ischemia, AD should be quickly recognized as a potential cause of new-onset neurological manifestations.