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This article has been peer reviewed. It is the authors' final version prior to publication in The American Journal of Emergency Medicine

Volume 31, Issue 1, January 2013, Pages: 269.e1-269.e2

The published version is available at DOI: 10.1016/j.ajem.2012.04.029. Copyright © Elsevier Inc.


Emergency 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 CT 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 prior to administering thrombolytics.

CT Head- Figure 1.tif (111 kB)
Figure 1

Chest Xray- Figure 2.tif (6745 kB)
Figure 2

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