Q: All of the following can be a clinical sign or symptom of Acute Aortic Dissection except?

A) Stroke 
B) Horner syndrome 
C) Hoarseness 
D) Complete heart block
E) Low D-Dimer


Answer: E

Objective of above question is to emphasize the unusual presentations of acute aortic dissection which can be devastating if missed or read wrong. It is important to understand that presentation of stroke with negative c/o chest pain and negative CT scan may lead to infusion of thrombolytic which would be catastrophic in acute aortic dissection. Propagation of the dissection proximal into the carotid arteries or even diminished carotid blood flow may present acute aortic dissection as stroke. Expanding aneurysm may cause horner syndrome due to compression  on the superior cervical sympathetic ganglion, and hoarseness due to compression of the left recurrent laryngeal nerve. 

Low D-Dimer actually rules out Aortic dissection.