Chronic Aortic Dissection Presenting as Aphasia

Acute aortic dissection (AAD) is a fatal disease and delay in diagnosis results in deteriorated prognosis. A 55-year-old man presented to our hospital with aphasia because of a suspected stroke. Although the lack of pain made diagnosis difficult, we diagnosed Stanford type A AD as the underlying cause of his stroke. Two possible explanations were considered for the lack of pain. First, although the stroke was caused by AD, the stroke itself prevented the patient from feeling the pain. Second, the aphasia prevented him from complaining about the pain. Therefore, we believe that physicians require a high clinical index of suspicion for AD considering the possibility of painless AD or miscommunication secondary to aphasia.