• Am J Emerg Med · Jan 2013

    Case Reports

    Aortic dissection presenting as gait disturbance: a case report.

    • Michael Estreicher, Joseph Portale, and Bernard Lopez.
    • Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19102, USA. michael.estreicher@jeffersonhospital.org
    • Am J Emerg Med. 2013 Jan 1; 31 (1): 269.e1269.e2692269.e1-2.

    AbstractEmergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55-year-old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head computed tomography demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest x-ray should always be obtained before administering thrombolytics.

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