Asian Journal of Cardiology Research

Background: Acute Stanford type A aortic dissection is a life-threatening condition that classically presents with abrupt chest or back pain and requires immediate surgical management. However, atypical presentations are frequent and may complicate diagnosis. Neurological manifestations occur in up to 30% of cases and are associated with diagnostic delay and increased mortality. Among these, isolated acute confusion as the initial presentation is exceptionally rare and remains poorly recognized.

Case Presentation: We report the case of a 59-year-old woman with Hypertension who initially presented to the emergency department with retrosternal chest pain that resolved spontaneously and was followed five days later by isolated acute confusion. On readmission, she had no chest pain, focal neurological deficits, hypotension, shock, or signs of internal bleeding, but exhibited severe hypoxemia. Initial neurological investigations, including brain imaging, were unremarkable. Chest X-ray revealed mediastinal widening, and contrast-enhanced computed tomography confirmed an acute Stanford type A aortic dissection extending from the origin of the left subclavian artery to the celiac trunk, without involvement of the supra-aortic vessels. Emergency surgical replacement of the ascending aorta under cardiopulmonary bypass was promptly performed.

Results: The postoperative course was overall favorable despite minor complications, with rapid hemodynamic stabilization and complete resolution of neurological symptoms. No postoperative delirium or neurological deficits were observed. The patient was discharged in good clinical condition and scheduled for outpatient cardiology follow-up.

Conclusion: This case highlights that acute aortic dissection may present with isolated acute confusion in the absence of chest pain or focal neurological signs. Clinicians should maintain a high index of suspicion for aortic dissection in patients with unexplained acute confusional states, particularly when cardiovascular risk factors are present. Early thoracic imaging remains essential to prevent diagnostic delay and improve clinical outcomes.