Abstract
A 75-year-old male patient presented with sluggish speech and left hemiparesis. Brain magnetic resonance imaging (MRI) revealed acute multiple brain infarctions adjacent to both lateral ventricles. Although the patient received anticoagulant therapy, he exhibited fluctuations in his level of consciousness and hemiparesis. Carotid ultrasonography revealed severe stenoses and diffuse smooth-surfaced plaque in the bilateral common carotid artery, with laminated but relatively homogeneous, low-level internal echoes. These observations suggested dissecting aortic aneurysm. A diagnosis of Stanford type A dissection was made based on the results of contrast-enhanced computed tomography (CT) scans from the neck to the pelvis, and therefore emergency surgery was performed. Although rare, central nervous system symptoms can be the initial manifestation of this disease without typical chest pain, causing a delay in diagnosis. In the present case of dissecting aortic aneurysm, the initial symptom was left hemiparesis without chest pain, and the diagnosis was made successfully by carotid ultrasonography.
