Status epilepticus as an initial presentation of aortic dissection: A case report

BACKGROUND: Status epilepticus (SE) as the initial presentation of aortic dissection in the absence of chest pain is very rare. We report a case of aortic dissection (AD), which presented as SE with markedly elevated levels of D-dimer, a reliable and sensitive index of fibrin deposition and stabilization. CASE REPORT: A 74-year-old Asian woman presented to the emergency department (ED) with an altered mental state following three consecutive generalized tonic-clonic seizures at home. Her initial vital signs were normal, and the head CT scan was non-informative. Most of the laboratory results were normal, but the D-dimer levels were markedly elevated. About 90 minutes after arriving at the ED, the patient developed another tonic-clonic seizure for about three-four minutes. Emergent chest CT revealed type A AD with hemopericardium. During preparation for the emergency operation, the patient suffered a cardiac arrest. Despite performing cardiopulmonary resuscitation (CPR) for 35 minutes, the patient died. CONCLUSIONS: The goal of this case report is to make clinicians aware of the possibility that new-onset SE with elevated D-dimer levels can be an indication of acute AD type A in the absence of typical symptoms.