https://doi.org/10.4081/monaldi.2021.1662

A "sneaky" symptom of aortic dissection. Brief literature review, physiopathology and diagnostic tools management

Vol. 91 No. 2 (2021)
Submitted: October 29, 2020
Accepted: December 23, 2020
Published: March 9, 2021
Aortic dissection, Headache, Echocardiogram, Transesophageal echocardiogram, CT angiography, MRI
Abstract Views: 1336
PDF: 828
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Authors

Carlo Uran
carlura@libero.it
https://orcid.org/0000-0001-7661-4963
Cardiology and Intensive Care Unit, “San Giuseppe e Melorio” Hospital, Santa Maria Capua Vetere, Italy, Italy.
Angela Giojelli
Diagnostic Imaging Unit, “San Giuseppe e Melorio” Hospital, Santa Maria Capua Vetere, Italy, Italy.

Aortic diseases cover a large spectrum of conditions, such as aortic aneurysm and acute aortic syndromes (i.e., dissections, intramural hematoma, penetrating atherosclerotic ulcer, traumatic aortic injuries, and pseudoaneurysms), genetic diseases (e.g., Marfan syndrome) and congenital abnormalities, such as coarctation of the aorta. These conditions may have an acute presentation; thus, if the acute aortic syndrome is the first sign of the disease, the prognosis is extremely poor. Prompt diagnosis and timely therapy are therefore mandatory. In this paper, we discuss a deceptive symptom of painless aortic dissection and its physiopathology. Furthermore, we briefly review the literature and discuss the management of diagnostic tools.

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Scopus
Google Scholar
Europe PMC
Sampson UK, Norman PE, Fowkes FG, et al. Global and regional burden of aortic dissection and aneurysms: mortality trends in 21 world regions, 1990 to 2010. Glob Heart 2014;9:171-80. DOI: https://doi.org/10.1016/j.gheart.2013.12.010
Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. Eur Heart J 2014;35:2873-926. DOI: https://doi.org/10.1093/eurheartj/ehu281
Singh S, Huang JY, Sin K, Charles RA. Headache: an unusual presentation of aortic dissection. Eur J Emerg Med 2007;14:47-9. DOI: https://doi.org/10.1097/01.mej.0000224435.89740.bc
Ko J-I, Park T. Headache: a rare manifestation of Debakey type I aortic dissection. Am J Emerg Med 2014;32;291.e5-6. DOI: https://doi.org/10.1016/j.ajem.2013.10.022
Parikh M, Agrawal A, Thyagarajan B, et al. Temporoparietal headache as the initial presenting symptom of a massive aortic dissection. Case Rep Emerg Med 2015;2015:626825. DOI: https://doi.org/10.1155/2015/626825
Sturzenegger M. Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. J Neurol1995;242:231-8. DOI: https://doi.org/10.1007/BF00919596
Hagan PG, Nienaber CA, Isselbacher EM, et al. The international registry of acute aortic dissecion (IRAD). JAMA 2000;283:897-903. DOI: https://doi.org/10.1001/jama.283.7.897
Gaul C, Dietrich W, Friedrich I, et al. Neurological symptoms in type A aortic dissections. Stroke 2007;38:292-7. DOI: https://doi.org/10.1161/01.STR.0000254594.33408.b1
Bossone E, Corteville DC, Harris KM, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation 2013;128:S175-9. DOI: https://doi.org/10.1161/CIRCULATIONAHA.112.000327
Shono Y, Akahoshi T, Mezuki S, et al. Clinical characteristics of type A acute aortic dissection with symptom of the central nervous system. Am J Emerg Med 2017;35:1836-8. DOI: https://doi.org/10.1016/j.ajem.2017.06.011
Park K-H, Chung S, Kim DJ, et al. Natural history of moderately dilated tubular ascending aorta: implications for determining the optimal imaging interval. Eur J Cardiothorac Surg 2017;51:959-64. DOI: https://doi.org/10.1093/ejcts/ezx024
Gagné-Loranger M, Dumont E, Voisine P, et al. Natural history of 40-50 mm root/ascending aortic aneurysms in the current era of dedicated thoracic aortic clinics. Eur J Cardiothorac Surg 2016;50:562-6. DOI: https://doi.org/10.1093/ejcts/ezw123
Kim JB, Spotnitz M, Lindsay ME, et al. Risk of aortic dissection in the moderately dilated ascending aorta. J Am Coll Cardiol 2016;68:1209-19. DOI: https://doi.org/10.1016/j.jacc.2016.06.025
Angeloni E, Vitaterna A, Pirelli M, Refice S. Effects of statin therapy on ascending aorta aneurysms growth: a propensity-matched analysis. Int J Cardiol 2015;191:52-5. DOI: https://doi.org/10.1016/j.ijcard.2015.05.001
Vapnik JS, Kim JB, Isselbacher EM, et al. Characteristics and outcomes of ascending versus descending thoracic aortic aneurysms. Am J Cardiol 2016;117:1683-90. DOI: https://doi.org/10.1016/j.amjcard.2016.02.048
Rust H, Kimmig H. Thunderclap headache as the main symptom of an acute aortic dissection type A. J Neurol 2013;260:1925-6. DOI: https://doi.org/10.1007/s00415-013-6969-0
Heistad DD, Marcus ML. Role of vasa vasorum in nourishment of the aorta. Blood Vessels 1979;16:225-38.
Tatuene JK, Excoffier S, Vallee JP, Kleinschmidt A. Putative pathophysiological mechanisms in recurrent hemicrania from aortic dissection: a case report. BMC Res Notes 2015;8:246. DOI: https://doi.org/10.1186/s13104-015-1223-8
Ahn AH, Basbaum AI. Tissue injury regulates serotonin 1D receptor expression: implications for the control of migraine and inflammatory pain. J Neurosci 2006;26:8332-8. DOI: https://doi.org/10.1523/JNEUROSCI.1989-06.2006
Dray A. Inflammatory mediators of pain. Br J Anaesth 1995;75:125-31. DOI: https://doi.org/10.1093/bja/75.2.125
Rouvière H, Delmas A. [Nerfs du tronc].[In French]. In: Delmas V, ed. Anatomie humaine descriptive, topographique et fonctionnelle. Paris: Masson; 2002. p. 271-98.
Almeida TF, Roizenblatt S, Tufik S. Afferent pain pathways: a neuro anatomical review. Brain Res 2004;1000:40-56. DOI: https://doi.org/10.1016/j.brainres.2003.10.073
Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg 2010;140:784-9. DOI: https://doi.org/10.1016/j.jtcvs.2009.11.014
Biousse V, D'Anglejan-Chatillon J, Massiou H, et al. Head pain in non-traumatic carotid artery dissection: a series of 65 patients. Cephalalgia 1994;14:33-6. DOI: https://doi.org/10.1046/j.1468-2982.1994.1401033.x
Erbel R, Aboyans V, Boileau C, et al. [2014 ESC Guidelines on the diagnosis and treatment of aortic diseases].[Article in Polish]. Kardiol Pol 2014;72:1169-252. DOI: https://doi.org/10.5603/KP.2014.0225
Mokashi SA, Svensson LG. Guidelines for the management of thoracic aortic disease in 2017. Gen Thorac Cardiovasc Surg 2019;67:59-65. DOI: https://doi.org/10.1007/s11748-017-0831-8
Alter SM, Eskin B, Allegra JR. Diagnosis of aortic dissection in emergency department patients is rare. West J Emerg Med 2015;16:629-31. DOI: https://doi.org/10.5811/westjem.2015.6.25752
Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:e266-369.
Kurabayashi M, Miwa N, Ueshima D, et al. Factors leading to failure to diagnose acute aortic dissection in the emergency room. J Cardiol 2011;58:287-93. DOI: https://doi.org/10.1016/j.jjcc.2011.07.008
Rosman HS, Patel S, Borzak S, et al. Quality of history taking in patients with aortic dissection. Chest 1998;114:793-5. DOI: https://doi.org/10.1378/chest.114.3.793
Klompas M. Does this patient have an acute thoracic aortic dissection? JAMA 2002;287:2262-72. DOI: https://doi.org/10.1001/jama.287.17.2262
Czerny M, Schmidli J, Adler S, et al. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019;55:133-62. DOI: https://doi.org/10.1093/ejcts/ezy313
Nicosia A, Greco G, Felis S, et al. [Diagnostic accuracy of transesophageal echocardiography in the diagnosis of aortic dissection: comparison with computerized axial tomography].[Article in Italian]. Cardiologia 1995;40:329-9.
von Tengg-Kobligk HM, Giesel FL. Contrast agents in radiology. In: Miller CK, Schwartz, LH, eds. Medical imaging in clinical trials. London: Springer; 2014. p. 327-57. DOI: https://doi.org/10.1007/978-1-84882-710-3_15
Fukui T. Management of acute aortic dissection and thoracic aortic rupture. J Intensive Care 2018;6:5. DOI: https://doi.org/10.1186/s40560-018-0287-7

How to Cite

Uran, Carlo, and Angela Giojelli. 2021. “A ‘sneaky’ Symptom of Aortic Dissection. Brief Literature Review, Physiopathology and Diagnostic Tools Management”. Monaldi Archives for Chest Disease 91 (2). https://doi.org/10.4081/monaldi.2021.1662.
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