Painless aortic dissection presenting as hoarseness of voice: Cardiovocal syndrome: Ortner's syndrome

Most of the neurological manifestations of the aortic dissection are due to neuronal ischemia secondary to either extension of the dissection process into a branch artery, or compression of an artery by the false lumen of the dissecting aortic hematoma. However, the enlarging false lumen may directl y compress on an adjacent nerve, causing neuronal injury resulting in neuro logical symptoms. This may particularly take place when a distal intimal te ar does not decompress the false lumen, resulting in formation of an expand ing blind pouch. About 10% of aortic dissections are painless and may prese nt with symptoms secondary to the complications of the dissection, Although cardiovocal syndrome, or Ortner's syndrome (hoarseness of voice due to inv olvement of recurrent laryngeal nerve in cardiovascular diseases) has been described with aortic dissection, it has not been reported as an initial pr esenting feature of this disorder. This report describes the first case of painless aortic dissection presenting with hoarseness of voice, the cardiov ocal syndrome. The hoarseness remained the only symptom throughout the enti re course of the disease, The aortic dissection was not suspected initially . During surgical exploration, the recurrent laryngeal nerve was found comp ressed by the false lumen at the level of aortic arch, Aortic root replacem ent was performed successfully, resulting in complete resolution of the hoa rseness. The neurological manifestations of aortic dissection, and the card iovocal syndrome, are discussed. Copyright (C) 1999 by W.B. Saunders Compan y.