Not Every Unilateral Weakness Is Stroke

1Easton Hospital Academic Affiliate Drexel University, Easton, PA
2Easton Hospital. Academic Affiliate Drexel University, Easton, PA
3Easton Hospital. Academic Affiliate Drexel University, Easton, PA

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 297

Case Presentation:

A 47‐year‐old male white male with no significant past medical history presented with sudden onset of severe shortness of breath, diaphoresis, global amnesia, and weakness and paresthesia of the left upper extremity, which occurred half an hour prior to presentation. A stroke alert was called, and the patient was evaluated for possible thrombolytic therapy. Patient denied chest pain, but the history was unreliable as the patient could not remember what happened and kept asking repetitive questions. On physical examination, his vital signs were stable. The left pupil was sluggish to light. The left upper extremity had diminished sensation and decreased power. Auscultation revealed 2/6 diastolic murmur in the aortic area. Bilateral radial and femoral pulses were palpated; however, the left radial pulse seemed a little weaker than the right. Laboratory data including cardiac enzymes were within normal limits. CT scan of the brain and electrocardiogram were unremarkable. TTie chest x‐ray showed a questionable mildly widened mediastinum. CT scan of the chest and abdomen was immediately done and revealed a long and extensive dissecting aneurysm of the ascending aorta and aorta arch that began just above the aortic valve and extended into the left common carotid artery and proximal left subclavian artery and continued into both iliac arteries. Dissection did not involve celiac artery, superior mesenteric artery, or renal arteries. No thrombolytic therapy was given. The patient was immediately transferred to the operating room and underwent emergency vascular surgery. Subsequently, he made a near complete recovery from his deficits.

Discussion:

Acute aortic dissection is a rare and life‐Threatening event. A high index of clinical suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection. However, as in our case, establishing the diagnosis can be very difficult in the presence of atypical symptoms, which include the absence of chest or back pain. Aortic dissection can present with a variety of neurological and cardiac symptoms. Painless aortic dissection occurs in fewer than 10% of cases. Therapy with thrombolytics in a patient with acule aortic dissection who presents as a cerebrovascular accident is harmful and can even be catastrophic.

Conclusions:

This case emphasizes that we should not jump to thrombolytics in all cases of focal neurological weakness, considering the presentation to be a stroke. Aortic dissection should be carefully considered in all patients who present with transient global amnesia or other neurological symptoms, regardless of whether they complain of pain. This has tremendous therapeutic implications, as thrombolytics are absolutely contraindicated in patients with aortic dissection.

Author Disclosure:

M. Krishnamurthy, none; H. Liu, none: A. Kumar, none.

To cite this abstract:

Krishnamurthy M, Liu H, Kumar A. Not Every Unilateral Weakness Is Stroke. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 297. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/not-every-unilateral-weakness-is-stroke/. Accessed December 11, 2019.

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