SHM Converge Scientific Abstract ePoster Gallery-A Stroke of Misfortune of Aortic Proportion

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This case describes a 61-year-old man with hypertension, asthma, and morbid obesity who presented with left-sided numbness involving the arm, chest, and face, along with back pain and shortness of breath. He denied weakness, and his exam showed preserved strength but decreased sensation. Initial workup for stroke and cardiac causes was unrevealing. Chest X-ray showed a tortuous aorta and enlarged cardiac silhouette. An abdominal ultrasound, ordered for mildly abnormal liver tests, incidentally revealed a free intimal flap in the abdominal aorta, prompting CT angiography, which confirmed a Stanford type A aortic dissection extending from the thoracic aortic root to the left external iliac artery.<br /><br />Because the presentation was atypical and the diagnosis was unexpected, the dissection was initially easy to miss. Neurologic symptoms such as numbness, tingling, or weakness can occur in aortic dissection due to compromised blood flow and may be present in up to 40% of cases. This patient likely had a dissection that had been progressing for more than a week, possibly explaining his prior outside-hospital visit and worsening symptoms.<br /><br />Management focused on urgent surgical consultation and strict hemodynamic control before definitive repair. He was treated with esmolol, then nicardipine, to reduce stress on the aorta while awaiting transfer to a center capable of managing a dissection of this extent. He underwent thoracic endovascular aortic repair (TEVAR), but the postoperative course was catastrophic, complicated by refractory shock, multiorgan failure, CRRT, ECMO, and ultimately death.<br /><br />The case emphasizes that aortic dissection may present with uncommon neurologic symptoms and can be overlooked when symptoms mimic more common diagnoses. Early recognition, prompt imaging, immediate surgical involvement, and blood pressure/heart rate control are critical to improving survival.

Asset Subtitle

Priyen M. Patel

Meta Tag

Author List Niraj Mehta, Priyen M. Patel

Category Clinical Vignettes

Concept Aortic Dissection

Concept Type A Aortic Dissection

Concept Computed Tomography Angiography

Concept Beta Blockers

Concept Cardiothoracic Surgery Consultation

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Priyen M. Patel

Track Adult

Keywords

aortic dissection

Stanford type A

neurologic symptoms

left-sided numbness

CT angiography

thoracic endovascular aortic repair

blood pressure control

esmolol

nicardipine

multiorgan failure

Aortic Dissection

Type A Aortic Dissection

Computed Tomography Angiography

Beta Blockers

Cardiothoracic Surgery Consultation