Acute aortic dissection case with stroke presentation.

Year 2020, Volume: 2 Issue: 4, 123 - 126, 29.10.2020

Meral Seferoglu , Nizameddin Koca , Barış Şensoy

https://doi.org/10.46310/tjim.770428

Abstract

The correct diagnosis of acute aortic syndrome complicated by neurologic symptoms is essential. Performing thrombolytic therapy for acute-stage cerebral infarction would probably be the reason for fatal outcomes. We herein report the case of a 63-year-old man who presented with left hemiparesis and paraparesis. An acute myocardial infarction was excluded by electrocardiography and blood tests. Head computed tomography (CT) showed no remarkable findings. Although there was no chest pain, it was found in CT-angiography that he has an intramural hematoma in the ascending aorta and a severe dissection in the descending aorta. Aortic dissection may mimic acute stroke, in order to make the right decision about the treatment of acute aortic syndrome with neurologic complications, the benefits and risks should therefore be considered in individual patients.

Keywords

aort dissection, paraparesia, stroke, tPa

References

• Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903. doi: 10.1001/jama.283.7.897.
• Butler J, Davies AH, Westaby S. Streptokinase in acute aortic dissection. BMJ. 1990 Feb 24;300(6723):517-9. doi: 10.1136/bmj.300.6723.517.
• Melchior T, Hallam D, Johansen BE. Aortic dissection in the thrombolytic era: early recognition and optimal management is a prerequisite for increased survival. Int J Cardiol. 1993 Nov;42(1):1-6. doi: 10.1016/0167-5273(93)90095-x.
• Fried LC, Aparicio O. Experimental ischemia of the spinal cord. Histologic studies after anterior spinal artery occlusion. Neurology. 1973 Mar;23(3):289-93. doi: 10.1212/wnl.23.3.289.
• Garcin R, Godlewski S, Lapresle J. [Acute pseudopoliomyelitic myelomalacia. (Massive necrotic lesions of the anterior horns in the lumbosacral spinal cord)]. Rev Neurol (Paris). 1969 Oct;121(4):487-91.
• Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology. 1996 Aug;47(2):321-30. doi: 10.1212/wnl.47.2.321.
• Waldrop JE, Stoneham AE, Tidwell AS, Jakowski RM, Rozanski EA, Rush JE. Aortic dissection associated with aortic aneurysms and posterior paresis in a dog. J Vet Intern Med. 2003 Mar-Apr;17(2):223-9.
• Inamasu J, Hori S, Yokoyama M, Funabiki T, Aoki K, Aikawa N. Paraplegia caused by painless acute aortic dissection. Spinal Cord. 2000 Nov;38(11):702-4. doi: 10.1038/sj.sc.3101087.
• Grenvick A, Ayres SM, Holbrook PR, Shoemaker WC, eds. Textbook of Critical Care. 4th ed. Philadelphia: WB Saunders; 2000. p:1118–1119.
• Karmody AM, Powers SR, Monaco VJ, Leather RP. “Blue toe” syndrome. An indication for limb salvage surgery. Arch Surg. 1976 Nov;111(11):1263-8. doi: 10.1001/archsurg.1976.01360290097015.