Clinical Communications: Adults| Volume 49, ISSUE 5, P627-629, November 2015

Aortic Dissection Presenting as “Hysteria”



      Patients with medical conditions may present with psychiatric symptoms, which may lead to worse physical health care. Here we present the case of a patient with acute aortic dissection masked by psychiatric symptoms after a stressful event.

      Case Report

      A 29-year-old female medical student presented to the Emergency Department (ED) complaining about the feeling of “hysteria” after an argument with her boyfriend earlier the same day. She did not report other symptoms or pain. Careful physical examination, initially impeded by the patient's agitation, revealed pulseless extremities. Blood gas analysis showed metabolic acidosis. Transthoracic echocardiography and computed tomography ultimately led to the correct diagnosis: Stanford Type-A aortic dissection.

      Why Should an Emergency Physician Be Aware of This?

      Medical conditions requiring acute diagnostic work-up and therapy may present with psychiatric symptoms. Increased awareness and the use of standardized operating procedures in the ED may prevent fatal misdiagnoses in these patients.


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        • Hall R.C.
        • Popkin M.K.
        • Devaul R.A.
        • Faillace L.A.
        • Stickney S.K.
        Physical illness presenting as psychiatric disease.
        Arch Gen Psychiatry. 1978; 35: 1315-1320
        • Jones S.
        • Howard L.
        • Thornicroft G.
        ‘Diagnostic overshadowing’: worse physical health care for people with mental illness.
        Acta Psychiatr Scand. 2008; 118: 169-171
        • Shefer G.
        • Henderson C.
        • Howard L.M.
        • Murray J.
        • Thornicroft G.
        Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms – a qualitative study.
        PLoS One. 2014; 9: e111682
        • Hagan P.G.
        • Nienaber C.A.
        • Isselbacher E.M.
        • et al.
        The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.
        JAMA. 2000; 283: 897-903
        • Raghupathy A.
        • Nienaber C.A.
        • Harris K.M.
        • et al.
        Geographic differences in clinical presentation, treatment, and outcomes in type A acute aortic dissection (from the International Registry of Acute Aortic Dissection).
        Am J Cardiol. 2008; 102: 1562-1566
        • Spittell P.C.
        • Spittell J.A.
        • Joyce J.W.
        • et al.
        Clinical features and differential diagnosis of aortic dissection: experience with 236 cases (1980 through 1990).
        Mayo Clin Proc. 1993; 68: 642-651
        • Schlicht K.F.
        • Mann K.
        • Jungmann F.
        • et al.
        A 48-year-old woman with panic attacks.
        Lancet. 2014; 384: 280
        • Stone J.
        • Smyth R.
        • Carson A.
        • et al.
        Systematic review of misdiagnosis of conversion symptoms and “hysteria”.
        BMJ. 2005; 331: 989