共查询到20条相似文献,搜索用时 31 毫秒
1.
Sukhvinder Singh John Y Huang Kenny Sin Rabind A Charles 《European journal of emergency medicine》2007,14(1):47-49
The most common presenting symptom of aortic dissection is chest pain - headache as the initial manifestation is rare. We report a patient with a history of hypertension who presented with severe bifrontal headache, and was found to have an acute aortic dissection in the absence of carotid artery dissection. A discussion of the atypical presentation and possible pathophysiology follows. 相似文献
2.
《The American journal of emergency medicine》1998,16(1):49-51
Acute aortic dissection may have variable presentations, making the diagnosis clinically challenging. Acute neurologic syndromes secondary to dissection of the aorta are uncommon. However, including aortic dissection in the differential diagnosis is imperative. This report describes the first reported case of an acute thoracic aortic dissection presenting with the chief complaint of unilateral lower extremity numbness. Peripheral ischemic neuropathy as the result of vascular occlusion is uncommon. The pathophysiology and clinical manifestations of ischemic neuropathies in the setting of acute aortic dissection are discussed. 相似文献
3.
Acute dissection of the aorta can be one of the most dramatic of cardiovascular emergencies. Its symptoms can occur abruptly and progress rapidly. Prompt recognition and appropriate intervention is crucial. However, not all aortic dissections present with classic symptoms of abrupt chest, back, or abdominal pain, and the diagnosis may be missed. A 63-year-old woman presented with transient loss of lower extremity motor and sensory function as the only symptom of an acute thoracoabdominal aortic dissection. Aortic dissection presenting as a transient neurologic syndrome is quite unusual. The sudden onset of weakness and parasthesia can result from the interruption of blood flow to the spinal cord. These symptoms of acute spinal cord ischemia, suggestive of a serious cardiovascular event, must be recognized and thoroughly investigated. 相似文献
4.
An 82-year-old woman with consciousness disturbance, left hemeparesis, and dysarthria was discovered at home by her family and was transported to a hospital. On arrival, she remained in a sleepy and disorientated and shock state. She complained of nausea but no chest or back pain. She obtained stable circulation after infusion. Her chest roentgen results showed widening of the mediastinum and the existence of a separation of the intimal calcification from the outer aortic soft tissue border, thus suggesting a Stanford A–type aortic dissection. Her head computed tomography depicted no signs of cerebral infarction. Because she did not complain of any pain, the possibility of acute phase aortic dissection was rejected. A permissive hypertensive therapy was initiated. Next day, she suddenly died. We diagnosed that she had died of a Stanford A–type aortic dissection based on the following facts: (1) patients presenting with stroke due to a Stanford A–type aortic dissection tend to have left hemiparesis because of malcirculation of the innominate artery and (2) a patient presenting with stroke by aortic dissection may have hypotension, which is unusual in standard stoke cases. Ischemic stroke induced by aortic dissection is not common among the patients with aortic dissection. However, given the high morbidity and mortality after misdiagnosis of aortic dissection, patients with ischemic stroke with left hemiparesis or shock should be evaluated by enhanced truncal computed tomography. 相似文献
5.
Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. We report a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. She was subsequently found to have an extensive aortic dissection involving both carotid arteries. The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound. 相似文献
6.
Vertebral artery dissection is a lesser known but significant cause of stroke in young, healthy people. Given its infrequency of presentation, emergency physicians may not always recognize its common symptoms--vertigo, diplopia, ataxia, and dysarthria--as a stroke. In this case report, we describe a patient with vertebral artery dissection presenting with atypical symptoms and discuss the epidemiology, risk factors, presentation, clinical examination findings, imaging modalities, and treatment of this disease. 相似文献
7.
Dawood Darbar MD Kenton Zehr MD Jerome F. Breen MD Roger Click MD PhD 《Journal of the American Society of Echocardiography》2000,13(12):1130-1134
Transesophageal echocardiography relies on the presence of an undulating intimal flap for the diagnosis of aortic dissection. Furthermore, to distinguish true dissection from echo artifacts, the flap has to be identified in more than one view, and it must have a motion independent of the aortic wall. We describe the transesophageal echocardiography appearance of a localized aortic dissection with atypical features for an intimal flap. Awareness of this unusual echocardiographic appearance of an intimal flap will avoid misdiagnosis of the potentially serious acute aortic dissection. 相似文献
8.
Acute thoracic aortic dissection: The basics 总被引:5,自引:0,他引:5
Karen Chen MD Joseph Varon MD FACP FCCP Olivier C. Wenker MD DEAA Deepinder K. Judge MD Robert E. Fromm Jr. MD MPH FACEP George L. Sternbach MD FACEP 《The Journal of emergency medicine》1997,15(6):637-867
With an increasing incidence, aortic dissection is the most common acute illness of the aorta. In the setting of chronic hypertension, with or without other risk factors for aortic dissection, this diagnosis should be considered a diagnostic possibility in patients presenting to the emergency department with acute chest or back pain. Left untreated, about 75% of patients with dissections involving the ascending aorta die within 2 weeks of an acute episode. But with successful initial therapy, the 5-year survival rate increases to 75%. Hence, timely recognition of this disease entity coupled with urgent and appropriate management is the key to a successful outcome in a majority of the patients. This article reviews acute thoracic aortic dissection, including ED diagnosis and management. 相似文献
9.
Luc M Beauchesne John P Veinot Maurice P Brais Ian G Burwash Kwan-Leung Chan 《Journal of the American Society of Echocardiography》2003,16(3):285-288
Several variants of aortic pathology must be considered in the differential diagnosis of the patient presenting with an acute aortic syndrome. In addition to aortic dissection, such entities include intramural hematoma, penetrating aortic ulcer, and localized intimal tear without dissection. These lesions, which lack a mobile intimal flap, may be difficult to correctly identify by transesophageal echocardiography or other imaging modalities. We present a case of an acute aortic syndrome with unusual features on transesophageal echocardiography. 相似文献
10.
11.
Occlusion of the right coronary artery (RCA) is an uncommon complication of type A aortic dissection. Aortic dissection and acute coronary syndrome (ACS) share a similar pathogenesis in atherosclerosis and hypertension. Consequently a patient with ischaemic risk factors presenting with chest pain and dynamic ECG change may well be incorrectly treated for ACS if careful attention is not paid to the presenting symptoms and signs. This case report describes a 59-year-old man who presented with chest pain, confusion and an ischaemic ECG and was initially treated for ACS. He subsequently deteriorated clinically and imaging confirmed type A aortic dissection complicated by RCA occlusion. Following emergent surgery with aortic root replacement and coronary artery bypass grafting he later made a good recovery. 相似文献
12.
Aylin Tugcu MD FESC Ozlem Yildirimturk MD FESC I.C. Cemsid Demiroglu MD Saide Aytekin MD FESC 《Journal of clinical ultrasound : JCU》2010,38(8):454-456
We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound 38:454–456, 2010 相似文献
13.
Background: Acute aortic dissection is a life-threatening disease that is often a diagnostic challenge in the Emergency Department (ED). Patients with acute aortic dissection often have underlying hypertension and atherosclerotic disease, and commonly present with acute-onset severe chest or back pain in their sixth or seventh decades of life. Aortic dissection, however, can also be seen in patients < 40 years old and may present chronically, with symptom duration longer than 2 weeks. Objective: We present an unusual case of chronic aortic dissection in a young patient, followed by a review of the literature on chronic aortic dissections and aortic dissections in young patients. Case Report: We report a case of chronic aortic dissection in a 32-year-old man with a history of untreated hypertension who presented to the ED with palpitations and mild shortness of breath. Conclusion: Acute and chronic thoracic aortic dissections can occur in patients of all ages, as well as in patients with atypical signs and symptoms. 相似文献
14.
We report the case of a 70-year-old man who had an acute dissection of a previously undiagnosed thoracic aortic aneurysm. The diagnosis was challenging because of the neurologic and hematologic complications that overwhelmed the clinical presentation. Three simultaneous complications of thoracic aortic aneurysm with dissection (ischemic stroke, consumption coagulopathy, and superior mesenteric infarction with gastrointestinal hemorrhage) made the case unique and the diagnosis difficult. 相似文献
15.
Bacterial meningitis secondary to a transethmoidal encephalocele presenting to the emergency department 总被引:2,自引:0,他引:2
Acute aortic dissection is an emergency that may not only cause significant morbidity but often results in death. A timely diagnosis can prove difficult in the event of an atypical presentation. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterized as ripping or tearing in nature. This article reports on a case of a completely painless acute dissection and rupture in a middle-aged man who presented with syncope. The diagnosis was made by a combination of clinical suspicion, emergent bedside echocardiography, and computed tomography scan. This patient underwent immediate surgery, and ultimately had a successful outcome. 相似文献
16.
Chronic aortic dissection as a cause of fever of unknown origin 总被引:1,自引:0,他引:1
Gorospe L Sendino A Pacheco R Alonso A Barbado FJ Vázquez JJ 《Southern medical journal》2002,95(9):1067-1070
Chronic aortic dissection presenting as a prolonged febrile syndrome is an uncommon condition. We believe that only 22 cases have been previously reported. We present a case of a patient with an aortic dissection whose diagnosis was delayed because persistent fever, malaise, and night sweats dominated his clinical picture. These complaints may be accompanied by an increased erythrocyte sedimentation rate, leukocytosis, thrombocytosis, and anemia of chronic disease. Knowledge of this atypical presentation, a high degree of suspicion, and investigation using an adequate imaging method will help to avoid missing this potentially lethal entity. 相似文献
17.
Kasher JA El-Bialy A Balingit P 《Journal of cardiovascular pharmacology and therapeutics》2004,9(3):211-218
Aortic dissection is a relatively uncommon but catastrophic illness classically thought to present with acute, sharp, chest pain with radiation to the back. However, aortic dissection can manifest in a number of different ways that include congestive heart failure, inferior myocardial infarction, stroke, focal pulse and neurologic deficits, abdominal pain, or acute renal failure. According to some studies, only about 80% of patients with type A dissection present with severe anterior chest pain, and only about 60% describe their pain as being sharp. Another series reports that treating clinicians fail to initially entertain the diagnosis of aortic dissection in up to 35% of cases. Many patients later found to have aortic dissection are initially suspected to have other conditions such as acute coronary syndrome, pericarditis, pulmonary embolism, or even cholecystitis. In this article we present a case of an unusual presentation of aortic dissection and a review of this condition. 相似文献
18.
The presentation of an AMI in the older person is often atypical, with a lower incidence of classic chest discomfort but increasing incidence of dyspnea, syncope, stroke, and acute confusion. Atypical presentation is especially common in those 85 years and older. The altered pattern of symptoms predisposes the elderly to a delayed or missed diagnosis. Delay in diagnosis may also occur when the ECG is nondiagnostic. In addition, enzyme elevations may be lower and fail to reflect the extent of myocardial damage. Thus, among the greatest challenges confronting critical care nurses is that of caring for elderly patients presenting with atypical AMI and concomitant polypathology. Nurses who are well informed about the normal age-related changes in the cardiovascular system contribute to more accurate and timely diagnosis and treatment of AMI in the elderly. 相似文献
19.
Lovrencic-Huzjan A Jurasic MJ Lovrencic-Prpic G Vukovic V Demarin V 《Ultraschall in der Medizin (Stuttgart, Germany : 1980)》2006,27(3):280-283
The diagnosis of aortic dissection is frequently missed at the time of hospital admittance. Neurological presentations are rare, and neuro-sonography is rarely used. We describe a patient with atypical clinical presentation of aortic arch dissection in whom neuro-sonological investigations showed a "cathedral like" haemodynamic spectrum of aortic regurgitation, directing the investigation towards the diagnosis. 相似文献
20.
目的 探讨主动脉夹层患者的患病危险因素、临床特征、诊治方法及预后.方法 对我院2005-2008年诊治的44例主动脉夹层患者临床资料进行回顾性分析.结果 主动脉夹层发生的常见病因是高血压.首发表现以胸痛为常见(部分病例以并发症为首发).CT和MRI检查对主动脉夹层的确诊率较超声检查高,但由于超声检查价格便宜,床旁操作方便,故有疑诊患者,可做常规超声检查.主动脉夹层的治疗有内科保守治疗,外科手术治疗和血管内带膜支架治疗.结论 高血压是主动脉夹层的主要危险因素,其临床表现复杂多变,误诊率高.内科治疗时血压控制多需多种降压药物联合应用,然而根据临床分型和病情采取外科手术、介入治疗可降低病死率和改善患者的预后. 相似文献