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What Lies behind the Ischemic Stroke: Aortic Dissection?

Deniz T, Dag E, Tulmac M, Azapoglu B, Alp C - Case Rep Emerg Med (2014)

Bottom Line: AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache.Case Report.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Faculty of Medicine, Kirikkale University, 71350 Kirikkale, Turkey.

ABSTRACT
Introduction. Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI) of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT) angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.

No MeSH data available.


Related in: MedlinePlus

Axial diffusion-weighted echo-planar MR image (apparent diffusion coefficient shows an area of restricted diffusion in right occipital lobe).
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fig1: Axial diffusion-weighted echo-planar MR image (apparent diffusion coefficient shows an area of restricted diffusion in right occipital lobe).

Mentions: In this case, a female patient, aged 71, with vertigo which started within the last one hour and progressed with weakness of arms and loss of the consciousness following speech disorder, has been brought to the emergency service. Her general condition was impaired; the vital status of the patient who was unconscious was evaluated (BP: 90/50 mmHg; pulse: 54 p/min; respiration: 18/min). Auscultation of heart revealed a regular rate and rhythm without any murmurs, and peripheral arterial pulses were symmetrical. Emergent chest X-ray and brain computed tomography were normal. Patient's diffusion MRI of brain was consistent with acute ischemia in right occipital lobe (Figure 1). Fibrinolytic therapy has been planned since symptoms started within two hours. Even though there was not any suspicion of aortic dissection in anamnesis and physical examination, bedside transthoracic echocardiography has been done. Echocardiography has shown significant aortic root dilatation and flap suspicion on a parasternal long axis view. Thereafter thorax CT angiography has been applied, and in the aortic root intimal flap has been detected which is consistent with aortic dissection which has been expanding from aortic arch to proximal bilateral carotid arteries (Figure 2). Based on these findings the treatment has been changed and surgical invention has been planned.


What Lies behind the Ischemic Stroke: Aortic Dissection?

Deniz T, Dag E, Tulmac M, Azapoglu B, Alp C - Case Rep Emerg Med (2014)

Axial diffusion-weighted echo-planar MR image (apparent diffusion coefficient shows an area of restricted diffusion in right occipital lobe).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4269200&req=5

fig1: Axial diffusion-weighted echo-planar MR image (apparent diffusion coefficient shows an area of restricted diffusion in right occipital lobe).
Mentions: In this case, a female patient, aged 71, with vertigo which started within the last one hour and progressed with weakness of arms and loss of the consciousness following speech disorder, has been brought to the emergency service. Her general condition was impaired; the vital status of the patient who was unconscious was evaluated (BP: 90/50 mmHg; pulse: 54 p/min; respiration: 18/min). Auscultation of heart revealed a regular rate and rhythm without any murmurs, and peripheral arterial pulses were symmetrical. Emergent chest X-ray and brain computed tomography were normal. Patient's diffusion MRI of brain was consistent with acute ischemia in right occipital lobe (Figure 1). Fibrinolytic therapy has been planned since symptoms started within two hours. Even though there was not any suspicion of aortic dissection in anamnesis and physical examination, bedside transthoracic echocardiography has been done. Echocardiography has shown significant aortic root dilatation and flap suspicion on a parasternal long axis view. Thereafter thorax CT angiography has been applied, and in the aortic root intimal flap has been detected which is consistent with aortic dissection which has been expanding from aortic arch to proximal bilateral carotid arteries (Figure 2). Based on these findings the treatment has been changed and surgical invention has been planned.

Bottom Line: AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache.Case Report.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Faculty of Medicine, Kirikkale University, 71350 Kirikkale, Turkey.

ABSTRACT
Introduction. Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI) of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT) angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.

No MeSH data available.


Related in: MedlinePlus