Subacute Stroke Following Aortic Root Dissection: A Clinical Case Report

Aortic root dissection is a medical emergency, usually presenting with chest pain/epigastric pain, with a high mortality rate of at least 20-30%. Early diagnosis is critical as early prompt intervention can reverse the mortality rate, which is estimated to increase by 1% to 1.4% in the first 48 hours. This case report highlights the diagnostic challenges of type A aortic root dissection if presented with non-specific symptoms, a high-mortality medical emergency. A 58-year-old presented with acute chest pain and a vacant episode but was initially discharged following unremarkable investigation results (ECG, troponin, and chest X-rays). Ten days later, he returned with expressive dysphagia secondary to a subacute cerebral infarct, leading to the eventual diagnosis of aortic root dissection initially seen on echocardiogram and later confirmed by CT angiography. The patient underwent the surgical repair but ultimately passed away from Escherichia (E.) coli sepsis postoperatively. Ultimately, this report reinforces the necessity of considering D-dimer or bedside transthoracic echo as part of a comprehensive initial assessment for suspected aortic root dissection, while simultaneously emphasising that definitive diagnosis and management planning rely on the dedicated CT angiography.