Indian Journal of Critical Care Case Report

Register      Login

VOLUME 3 , ISSUE 6 ( November-December, 2024 ) > List of Articles

CASE REPORT

Aortic Dissection Masquerading as a Stroke

Raghavendra Deshpande, Rajavardhan Rangappa, Narayana S Moola, Sanjana Anand

Keywords : Acute ischemic stroke, Aortic dissection, Case report, Ischemic infarct, Thrombolysis

Citation Information : Deshpande R, Rangappa R, Moola NS, Anand S. Aortic Dissection Masquerading as a Stroke. 2024; 3 (6):169-171.

DOI: 10.5005/jp-journals-11006-0126

License: CC BY-NC 4.0

Published Online: 19-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim and background: Aortic dissection is a life-threatening condition, it is a recognised cause of acute ischemic stroke. Aortic dissection is a contraindication to thrombolysis with recombinant tissue plasminogen activator (rt-PA). Consequently, the exclusion of aortic dissection is imperative before initiating anticoagulants or thrombolysis. Case description: We present a case of a 58-year-old female presented to the hospital with complaints of decreased responsiveness and giddiness at home. She was put on mechanical ventilator due to low GCS (Glasgow coma scale). Initial CT was normal, she was shifted to the ICU for further management. Later the same day of admission, she was noted to have right sided paucity of movement, MRI done showed acute infarcts in bilateral posterior and left anterior watershed zones suspicious of hemorrhagic transformation, flair intensity mismatch was not seen. Her ECHO showed septal hypokinesia and aortic regurgitation and a flap like structure, aortic dissection which was later confirmed by carotid Doppler and CT aortogram: showed Stanford A type of aortic dissection. The same day, she underwent ascending aorta and hemiarch replacement. Eventually discharged on day 17th of admission with minimal neurological deficit. Conclusion: Thrombolysis stands as a cornerstone in the management of acute ischemic stroke; however, the oversight of concurrent aortic dissection could gravely escalate both mortality and morbidity. Clinical significance: In the case presented, a vigilant clinical evaluation, complemented by prompt imaging and bedside echocardiography, was pivotal in the post hoc diagnosis of aortic dissection. This timely intervention was instrumental in steering an early therapeutic course, culminating in a positive patient prognosis.


PDF Share
  1. Hiraga S, Hirose T, Fukuba R, et al. A case of Stanford type A acute aortic dissection with preoperative extensive cerebral infarction successfully treated surgically. Heart Surg Forum 2022;25(5):E645–E648. DOI: 10.1532/hsf.4855
  2. Clouse WD, Hallett JW Jr, Schaff HV, et al. Acute aortic dissection: population-based incidence compared with degenerative aortic aneurysm rupture. Mayo Clin Proc 2004;79(2):176–180. DOI: 10.4065/79.2.176
  3. Mészáros I, Mórocz J, Szlávi J, et al. Epidemiology and clinicopathology of aortic dissection. Chest 2000;117(5):1271–1278. DOI: 10.1378/chest.117.5.1271
  4. Coady MA, Rizzo JA, Goldstein LJ, et al. Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin 1999;17(4):615–635; vii. DOI: 10.1016/s0733-8651(05)70105-3
  5. Gaul C, Dietrich W, Friedrich I, et al. Neurological symptoms in type A aortic dissections. Stroke 2007;38(2):292–297. DOI: 10.1161/01.STR.0000254594.33408.b1
  6. Gaul C, Dietrich W, Erbguth FJ. Neurological symptoms in aortic dissection: A Challenge for neurologists. Cerebrovasc Dis 2008;26(1):1–8. DOI: 10.1159/000135646
  7. Johnson GA, Prince LA. Aortic dissection and related aortic syndromes. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8th edition. McGraw Hill Medical.
  8. Guglielmi V, Groeneveld NS, Posthuma L, et al. Aortic dissection masquerading as a code stroke: a single-centre cohort study. Eur Stroke J 2020;5(1):56–62. DOI: 10.1177/2396987319883713
  9. Amr G, Boulouis G, Bricout N, et al. Stroke presentation of acute type A aortic dissection with 100% perfusion-weighted imaging-diffusion-weighted imaging mismatch: a call for urgent action. J Stroke Cerebrovasc Dis 2016;25(5):1280–1283. DOI: 10.1016/j.jstrokecerebrovasdis.2016.02.012
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.