Abstract

A patient presented with uniocular blindness and headache, which was initially suspected to be subarachnoid hemorrhage. The patient had a seven-year history of diabetes mellitus, hypertension and hypothyroidism, as well as a two-year history of congestive cardiac failure with aortic regurgitation. Upon autopsy, the patient was diagnosed with aortic dissection. There are no other known reports of such a presentation. This case demonstrates that aortic dissection can present without any classical features, and hence it is important to consider the possibility of dissection in patients with long-standing hypertension and acute neurologic symptoms associated with pain.

Key Points

* Emergency room physicians should have a high suspicion of aortic dissection in a patient with long-standing hypertension.

* Aortic dissection is a clinical chameleon that can have various presenting features; therefore, meticulous history and physical examination play a key role in saving lives.

* There can be changes in electrocardiogram mimicking acute myocardial infarction; therefore, it is important to rule out aortic dissection before attempting fibrinolysis, which can be disastrous in these patients.

* An elevated C-reactive protein, mild-to-moderate leukocytosis and slight elevations of bilirubin and lactic acid dehydrogenase can be present. More recently, the biochemical diagnosis of aortic dissection has become possible by identifying raised concentrations of smooth muscle myosin heavy chain.