Key result
An asymptomatic Stanford type A aortic dissection was identified as the embolic source for multiple cerebral infarctions in a 56-year-old man, highlighting the need to consider this diagnosis when D-dimer is elevated.
Case Report (n=1)
No
Painless Stanford type A aortic dissection should be considered as a potential embolic source in patients presenting with ischemic stroke in multiple vascular territories and elevated D-dimer.
May support surgery to avert recurrent stroke in painless type A dissection; single case leaves open need for validation.
A 56-year-old man presented to our hospital as he presented progressive hemiplegia of the right upper limb with no other symptoms, including chest pain. Inter-arm blood pressure difference was not observed. Laboratory investigations revealed an elevated D-dimer value (2.4 μg/ml). Chest X-ray study showed normal findings without widened mediastinum. Brain MRI showed acute multiple brain infarcts in the left posterior limb of the internal capsule and right pons on diffusion-weighted imaging. Bilateral internal carotid arteries were non-occlusive in MRA. Carotid duplex ultrasonography revealed normal internal carotid artery flow velocities bilaterally. Because ischemic lesions were found in multiple vascular territories, and D-dimer value was elevated, the patient underwent thoracic contrast-enhanced-CT to exclude malignant tumors. Stanford type A aortic dissection limited to the ascending aorta was detected. As the plaque had accumulated in the false lumen, we suspected that plaque in the false lumen could be an embolic source. After ascending aortic replacement surgery, brain infarction did not recur during hospitalization. In cases of ischemic stroke wherein multiple vascular territories are detected, and D-dimer value is elevated, even in patients without chest pain, the possibility of painless Stanford type A aortic dissection should be ruled out as an embolic source.
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Kitazaki et al. (2020) conducted a case report in Stanford type A aortic dissection with multiple cerebral infarctions (n=1). Ascending aortic replacement surgery was evaluated on Recurrence of brain infarction. An asymptomatic Stanford type A aortic dissection was identified as the embolic source for multiple cerebral infarctions in a 56-year-old man, highlighting the need to consider this diagnosis when D-dimer is elevated.
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