Acute total aortic dissection revealed by incoercible vomiting with multiple organ failure a case report.

Introduction and importance: Acute aortic dissections are an uncommon entity. The different clinical manifestations especially in younger patients with no predisposing factors make it challenging to diagnose, causing delayed care and high mortality. Case presentation: In this report we describe a case of a total aortic dissection in a young man revealed by intractable vomiting with abdominal and chest pain. The dissection extended to various branches of the aorta including brachiocephalic trunk and iliac arteries, and caused multiple organ failure due to the many branches arising from the false lumen. Clinical disscussion: This case highlights the importance of considering acute aortic dissections in younger patients presenting with multi-organ failure, as well as the importance of early transthoracic echocardiography assessment in establishing the diagnosis. Conclusion: Acute aortic dissections are life threatening events, early diagnosis and management are key to prevent death especially in patients with atypical symptoms.

Cerebral Salt Wasting Syndrome (CSW): An unusual cause of hypovolemia after spontaneous cerebral hemorrhage successfully treated with fludrocortisone.

Our objective is to demonstrate the interest of thinking about Cerebral salt wasting syndrome (CSW) in front of hyponatremia with severe hypovolemia after a brain injury, and at the same time the interest to differentiate between Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Cerebral salt wasting syndrome (CSW) as two etiologies to be evoked in front of a hyponatremia with brain injury. Case report: We report the case of a 63-year-old patient with a recent history of hemorrhagic stroke admitted for severe hypovolemic shock in whom the investigations find a very deep hypotonic hyponatremia secondary to a cerebral salt wasting syndrome successfully treated with fludrocortisone. Discussion: CWS is characterized by hypotonic hyponatremia associated with cerebral associated with hypovolemia, the difficulty of the diagnosis is explained by the points of convergences with SIADH which is also presented with hyponatremia. The treatment is based on filling with saline, if the symptoms are severe, hypertonic saline has its place. Fludrocortisone has proven its effectiveness in the correction of refractory hyponatremia in CWS. Conclusion: It is essential to differentiate between hyponatremia in CWS and hyponatremia in SIADH because the medical care is categorically different.