PDF(Pubmed)
Abstract：
Ascending aortic dissection is typically characterized by severe chest or back pain. However, its presentation can be atypical, leading to diagnostic challenges, especially in settings where classic symptomatology may not be evident. In this report, we described the case of a 74-year-old woman who presented to the emergency room of a rural community hospital with chief complaints of vertigo, nausea, and vomiting, without the classic symptoms of chest or back pain associated with aortic dissection. Despite initial treatment for autonomic dysregulation, the patient\'s symptoms persisted. Subsequent comprehensive assessments, including computed tomography angiography, revealed an ascending aortic dissection extending to the bilateral common carotid arteries. This atypical presentation, characterized by cerebral hypoperfusion and systemic hypotension without tachycardia, emphasizes the need to maintain a high suspicion index, even in the absence of hallmark symptoms. This case underscores the importance of considering the possibility of ascending aortic dissection in patients with nontraditional symptoms. Recognizing these atypical presentations is crucial for timely intervention, especially in rural settings with limited advanced diagnostic tools. This case also highlights potential sex disparities in symptom presentation, emphasizing the need for clinicians to recognize nontraditional symptoms in women. Rapid identification, evaluation, and management are imperative to prevent severe outcomes, and a multidisciplinary approach has proven to be the most effective in such cases.
摘要：
升主动脉夹层通常以严重的胸部或背部疼痛为特征。然而,它的呈现可以是非典型的，导致诊断挑战，尤其是在经典症状学可能不明显的情况下。在这份报告中,我们描述了一名74岁的妇女出现在农村社区医院急诊室的主要眩晕投诉，恶心,呕吐,没有与主动脉夹层相关的胸部或背部疼痛的经典症状。尽管最初对自主神经失调进行了治疗，病人的症状持续存在。随后的全面评估，包括计算机断层扫描血管造影,显示升主动脉夹层延伸到双侧颈总动脉。这个非典型的介绍，以脑灌注不足和无心动过速的全身性低血压为特征，强调需要保持较高的怀疑指数，即使没有标志性症状。此病例强调了考虑具有非传统症状的患者发生升主动脉夹层的可能性的重要性。认识到这些非典型的陈述对于及时干预至关重要，特别是在农村地区，先进的诊断工具有限。这个案例还突出了症状表现方面的潜在性别差异，强调临床医生需要识别女性的非传统症状。快速识别,评估，管理层必须防止严重的结果，在这种情况下，多学科方法已被证明是最有效的。
