Ongoing Blood Pressure Change in Both Upper Extremities: An Unusual Presentation of Aortic Dissection
Hung Yi Chen
DOI: 10.4236/ijcm.2011.24078   PDF   HTML     6,809 Downloads   11,230 Views  


Aortic dissection is a critical condition requiring immediate assessment and management. Patients with this condition usually present with severe chest pain and high blood pressure. However, because of the variety of presenting symptoms and features, it is a challenge to identify this condition, and patients are frequently misdiagnosed. The potentially critical course of aortic dissection can result in tragedy. We present the case of a 46-year-old woman who initially presented with a light headache and sensory loss in her right upper limb. She had a medical history of hypertension without regular medication, and her blood pressure (BP) was 110/67 mmHg on arrival. Four days later, she was sent to the emergency department again because she experienced transient loss of consciousness lasting for a few minutes. Her BP was 94/57 mmHg in the right arm and 89/54 in the left arm. She was admitted to the hospital, and the pulses in both upper limbs were impalpable on the following day. Chest magnetic resonance imaging (MRI) was arranged, and subsequently, aortic dissection was diagnosed. The case presented with unusual characteristics, which increased the difficulty in immediate correct diagnosis.

Share and Cite:

H. Yi Chen, "Ongoing Blood Pressure Change in Both Upper Extremities: An Unusual Presentation of Aortic Dissection," International Journal of Clinical Medicine, Vol. 2 No. 4, 2011, pp. 463-468. doi: 10.4236/ijcm.2011.24078.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] I. A. Khan and C. K. Nair, “Clinical, Diagnostic, and Management Perspectives of Aortic Dissection,” Chest, Vol. 122, No. 1, 2002, pp. 311-328. doi:10.1378/chest.122.1.311
[2] J. L. Prendes, “Neurovascular Syndromes in Aortic Dissection,” American Family Physician, Vol. 23, No. 6, 1981, pp. 175-179.
[3] T. P. Kuhlmun and R. P. Powers, “Painless Aortic Dissection: An Unusual Cause of Syncope,” Annals of Emergency Medicine, Vol. 13, No. 7, 1984, pp. 549-551. doi:10.1016/S0196-0644(84)80528-4
[4] J. Inamasu, S. Hori, M. Yokoyama, T. Funabiki, K. Aoki and N. Aikawa, “Paraplegia Caused by Painless Acute Aortic Dissection,” Spinal Cord, Vol. 38, No. 11, 2000, pp. 702-704.
[5] E. M. Donovan, G. K. Seidel and A. Cohen, “Painless Aortic Dissectoin Presenting as High Paraplegia: A Case Report,” Archives of Physical Medicine and Rehabilitation, Vol. 81, No. 10, 2000, pp. 1436-1438. doi:10.1053/apmr.2000.7158
[6] S. A. Rosen, “Painless Aortic Dissection Presenting as Spinal Cord Ischemia,” Annals of Emergency Medicine, Vol. 17, No. 8, 1988, pp. 840-842. doi:10.1016/S0196-0644(88)80567-5
[7] S. F. Holloway, P. B. Fayad, R. G. Kalb, J. B. Guarnaccia and S. G. Waxman, “Painless Aortic Dissection Presenting as a Myelopathy,” Journal of the Neurological Sciences, Vol. 120, 1993, pp. 141-144.
[8] C. Beach and D. Manthey, “Painless Acute Aortic Dissection Presenting as Left Lower Extremity Numbness,” The American Journal of Emergency Medicine, Vol. 16, No. 1, 1998, pp. 49-51. doi:10.1016/S0735-6757(98)90064-X
[9] J.B. Joo and A. J. Cummings, “Acute Thoracoabdominal Aortic Dissection Presenting as Painless, Transient Paralysis of the Lower Extremities: A Case Report,” The Journal of Emergency Medicine, Vol. 19, No. 4, 2000, pp. 333-337. doi:10.1016/S0736-4679(00)00264-X
[10] W. R. Greenwood and M. D. Robinson, “Painless Dissection of the Thoracic Aorta,” The American Journal of Emergency Medicine, Vol. 4, No. 4, 1986, pp. 330-333. doi:10.1016/0735-6757(86)90303-7
[11] I. A. Khan, N. Wattanasauwan and A. W. Ansari, “Painless Aortic Dissection Presenting as Hoarseness of Voice: Cardiovocal Syndrome; Ortner’s Syndrome,” The American Journal of Emergency Medicine, Vol. 17, No. 4, 1999, pp. 361-363. doi:10.1016/S0735-6757(99)90087-6
[12] I. M. Schoon, J. Holm and G. Sudow, “Lower-Extremity Ischemia in Aortic Dissection: Report of Three Cases,” Scandinavian Journal of Thoracic and Cardiovascular Surgery, Vol. 19, No. 1, 1985, pp. 93-95.
[13] T. J. White 3rd, M. L. Pinstein, R. L. Scott and R. E. Gold, “Aortic Dissection Manifested as Leg Ischemi,” Ajr American Journal of Roentgenology, Vol. 135, No. 2, 1980, pp. 353-356.
[14] R. Koushima, Y. Kikuchi, T. Sakurada and K. Kusajima, “A Case of Painless Standford Type A Acute Aortic Dissection Complicating Acute Occlusion of the Right Subclavian Artery,” Kyobu Geka, Vol. 51, No. 3, 1998, pp. 226-230.
[15] A. J. Singer and J. E. Hollander, “Blood Pressure: Assessment of Interarm Differences,” Archives of Internal Medicine, Vol. 156, No. 17, 1996, pp. 2005-2008.
[16] F. H. Ellis and O.T. Clagett, “Coarctation of the Aorta Proximal to the Left Subclavian Artery: Experience with Six Surgical Cases,” Annals of Surgery, Vol. 146, No. 2, 1957, pp. 145-151.
[17] D. C. Levinson, D. T. Edmeades and G. C. Griffith, “Abdominal Pain in Dissecting Aneurysm of the Aorta,” The American Journal of Medicine, Vol. 8, No. 4, 1950, pp. 474-479. doi:10.1016/0002-9343(50)90229-4
[18] H. M. Korns and P. H. Guinand, “Inequality of Blood Pressure in the Brachial Arteries, with Especial Reference to Disease of the Arch of the Aorta,” Journal of Clinical Investigation, Vol. 12, No. 1, 1933, pp. 143-154. doi:10.1172/JCI100485
[19] R. D. Judge, R. D. Currier, W. A. Gracie and M. M. Figley, “Takayasu’s Arteritis and the Aortic Arch Syndrome,” The American Journal of Medicine, Vol. 32, 1962, pp. 379-392. doi:10.1016/0002-9343(62)90128-6
[20] A. G. Morrow, J. A. Waldhausen, R. L. Peters, R. D. Bloodwell and E. Braunwald, “Supravalvular Aortic stenosis: Clinical, Hemodynamic and Pathologic Observations,” Circulation, Vol. 20, 1959, pp. 1003-1010.
[21] Y. von Kodolitsch, A. G. Schwartz and C. A. Nienaber, “Clinical Prediction of Acute Aortic Dissection,” Archives of Internal Medicine, Vol. 160, No. 19, 2000, pp. 2977-2982.
[22] M. J. Eisenberg, S. A. Rice, A. Paraschos, G. R. Caputo and N. B. Schiller, “The Clinical Spectrum of Patients with Aneurysms of the Ascending Aorta,” American Heart Journal, 125, No. 5, 1993, pp. 1380-1385. doi:10.1016/0002-8703(93)91011-3
[23] A. Carcia-Jimenez, A. Peraza-Torres and G. Martinez- Lopez, “Alvarez Dieguez I, Botana Alba CM. Cardiac Tamponade by Aortic Dissection in a Hospital without Cardiovascular Surgery,” Chest, Vol. 104, 1993, pp. 290- 291.
[24] A. Geirsson, J. E. Babaria, D. Swarr, M. G. Keane, Y. J. Woo, W. Y. Szeto and A. Pochettino, “Fate of the Residual Distal and Proximal Aorta after Acute Type A Dissection Repair Using a Contemporary Surgical Reconstruction Algorithm,” The Annals of Thoracic Surgery, Vol. 84, No. 6, 2007, pp. 1955-1964. doi:10.1016/j.athoracsur.2007.07.017
[25] J. C. Halstead, M. Meier, C. Etz, D. Spielvoqel, C. Bodian, M. Wurm, R. Shahani and R. B. Griepp, “The Fate of the Distal Aorta After Repair of Acute Type A Aortic Dissection,” The American Association for Thoracic Surgery, Vol. 133, No. 1, 2007, pp. 127-135. doi:10.1016/j.jtcvs.2006.07.043.
[26] F. S. Schoenhoff, J. Schmidli, F. S. Eckstein, P. A. Berdat, F. F. Immer and T. P. Carrel, “The Frozen Elephant Trunk: An Interesting Hybrid Endovascular-Surgical Technique to Treat Complex Pathologies of the Thoracic Aorta,” Journal of vascular surgery, Vol. 45, No. 3, 2007, pp. 597-599. doi:10.1016/j.jvs.2006.10.038
[27] T. Kim, T. D. Martin, W. A. Lee, P. Hess Jr., C. T. Klodell, C. G. Tribble, R. J. Feezor and T. M. Beaver, “Evoluation in the Management of the Total Thoracic Aorta,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 3, 2009,pp. 627-634. doi:10.1016/j.jtcvs.2008.11.012
[28] M. Czerny, R. Gottardi, D. Zimpfer, M. Schoder, M. Grabenwoger, J. Lammer, E. Wolner and M. Grimm, “Mid-Term Results of Supraaortic Transpositions for Extended Endovascular Repair of Aortic Arch Pathologies,” European Journal of Cardiothoracic Surgery, Vol. 31, No. 4, 2007, pp. 623-627. doi:10.1016/j.ejcts.2006.12.030
[29] P. Bergeron, N. Mangialardi, P. Costa, P. Coulon, V. Douillez, E. Serreo, I. Tuccimei, C. Cavazzini, F. Mariotti, Y. Sun and J. Gay, “Great Vessel Management for Endovascular Exclusion of Aortic Arch Aneurysms and Dissections,” European Journal of Cardiothoracic Surgery, Vol. 32, No. 1, 2006, pp. 38-45. doi:10.1016/j.ejvs.2005.12.023

Copyright © 2022 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.