UC Irvine Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health Title Seizure as Initial Manifestation of Aortic Dissection Type A Publication Date Seizure as Initial Manifestation of Aortic Dissection Type A

Josef Finsterer, Marlies Frank, Hans Keller, Adam Bastowanski
2010 Journal Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health   unpublished
Seizure as the initial manifestation of aortic dissection is rare. Case report: An 88-year-old female experienced a first generalized tonic clonic seizure, which was terminated with midazolam. Acute cerebral magnetic resonance imaging and angiography were non-informative. After awaking she complained about cramping pain in the right upper extremity, which was accompanied by involuntary flexion movements of the right upper extremity. Blood pressure was initially normal. Blood gases revealed
more » ... olic acidosis and blood chemical investigations a markedly increased D-dimer. Consecutively blood pressure declined and transthoracic echocardiography showed pericardial effusion. A computed tomography scan of the thorax revealed an aortic dissection type A. The patient died 16 hours after admission after cardiothoracic surgeons had refused surgical treatment. Conclusion: This case shows that a generalized tonic-clonic seizure may be the initial manifestation of an aortic dissection type A in the absence of thoracic chest pain and that brachyalgia may not develop earlier than with progression of the dissection. [West J Emerg Med. 2010; 11(5):510-511.]
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