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CRITICAL CARE AND TRAUMA

Aortic Dissection Mimicking Subarachnoidal Hemorrhage

Boris Nohé, MD^*, Ulrike Ernemann, MD, Gunnar Tepe, MD, Rainer Ritz, MD, and Dorothee Bail, MD^||

Departments of *Anaesthesiology and Intensive Care Medicine, Neuroradiology, Radiology, Neurosurgery, and ||Cardiothoracic and Vascular Surgery, Eberhard-Karls University Tübingen, Tübingen, Germany

Address correspondence and reprint requests to Dr. B. Nohé, Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany. Address e-mail to boris.nohe{at}uni-tuebingen.de.

In this report we describe a comatose patient with proximal aortic dissection who presented with the signs of subarachnoidal hemorrhage. Shortly before losing consciousness, the patient complained of an excruciating headache. Upon initial examination, neck stiffness and opisthotonos were present. The cardiovascular examination, chest radiograph, and cerebral computed tomography were normal. Eight hours later, the aortic dissection was verified by a thoracic computed tomography. This case shows that aortic dissection, which causes severe pain and possibly transient malperfusion of the carotid arteries, may present with the misleading signs of subarachnoidal hemorrhage but without classical symptoms of aortic syndromes.

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