We present the clinical case of an 80-year-old woman admitted to the emergency department with jaw pain and acute neurovascular impairment with right arm monoparesis, pulse deficit and pallor of the limb, without chest pain as a cardinal symptom. The history of arterial hypertension, aortic stenosis, and clinical manifestation suggested an acute vascular compromise, for which acute aortic syndrome (AAS) was suspected.  Chest x- rays revealed mediastinal widening; angio-CT scan confirmed type- A aortic dissection affecting the right subclavian artery (thrombosis). The patient passed away after expectant non-surgical management.

In the IRAD study (International Registry of Acute Aortic Dissection) conducted in 12 reference centers, it was observed that the clinical evidencing that chest pain occurs in 72.2% of patients ; for Spanish surveys such as RESA, this symptom presented in 95.9% ; the sudden onset of symptoms occurred in 95.5%, back pain 53%, abdominal pain 29%, and syncope (14% in RESA and 9.4% in IRAD studies). Recent publications describe increased neurological manifestations with respect to previous studies: 17% are limb motor deficits, being these manifestations more persistent in type-A dissection

In the present report, the patient was diagnosed under neurological findings; according to the literature, this type of manifestations correspond to less than 10% of the cases, including: syncope, coma, dysphonia, spinal cord injury or cerebrovascular accident , most of these are transient (in 15-40% of the cases) and explained by four physiopathological mechanisms: poor perfusion, hypotension, distal thromboembolism, and compression of peripheral nerves. The ischemic neuropathy of the limbs secondary to poor perfusion is mainly due to subclavian and femoral involvement in up to 10% . For European publications, the neurological deficit occurs in the same proportion but includes 8% of patients who present with pain in one limb

Diego Abreo is a specialist in emergency medicine from the CES University of Colombia. Emergency Physician at the Pablo Tobon Uribe Hospital in Medellín, Colombia.

Member of the American College of Emergency Physicians (ACEP® ). He has been a speaker at the congress of the Colombian Association of Specialists in Emergency and Emergency Medicine (ACEM®), and at the congress of the European Society For Emergency Medicine (EUSEM®). With great interest in cardiovascular emergencies