Key result
Patients with acute aortic dissection presenting with hemiparesis showed significantly lower systolic blood pressure, elevated D-dimer (47.4 vs 3.9 µg/ml), and widened mediastinum compared to ischemic stroke patients.
Observational (n=372)
No
Absolute Event Rate: 47.4% vs 3.9%
p-value: p=<0.05
Lower blood pressure, elevated D-dimer, and mediastinal widening on chest X-ray are useful clinical markers to distinguish acute aortic dissection from acute ischemic stroke.
May aid differentiation of aortic dissection in acute hemiparesis; leaves open prospective validation before changing practice.
要旨：【目的】急性胸部大動脈解離（AAD; acute aortic dissection）は初診時に胸部症状を呈さず脳虚血症状を主症状とすることで，AAD を見落とすことがある．このため，AAD と急性期脳梗塞との臨床像を比較検討し，両疾患の鑑別に有用な臨床的因子を明らかにした．【方法】Stanford A 型AAD 38例（麻痺を呈したものは8 例），脳梗塞（一過性脳虚血発作を含む）334 例の連続症例を対象とし，初診時の症状，心拍数，血圧，D-dimer 値，胸部X 線写真を後方視的に比較検討した．【結果】初診時血圧はAAD 群で脳梗塞群よりも有意に低値であった．D-dimer 値はAAD 群で脳梗塞群より高値であった．臥位胸部X 線写真では上縦隔/胸隔比，上縦隔/心臓比がAAD 群で有意に高かった．【結論】血圧，D-dimer 値，胸部X 線写真の所見が鑑別に有用な因子と考えられた．
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Ueno et al. (2014) conducted an observational in Acute ischemic stroke and acute aortic dissection (n=372). Acute aortic dissection vs. Acute ischemic stroke was evaluated on D-dimer level (µg/ml) (p=<0.05). Patients with acute aortic dissection presenting with hemiparesis showed significantly lower systolic blood pressure, elevated D-dimer (47.4 vs 3.9 µg/ml), and widened mediastinum compared to ischemic stroke patients.
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