Key result
Diagnostic imaging revealed an aortic dissection involving the carotid arteries in a 71-year-old woman presenting with acute stroke, changing the planned fibrinolytic therapy to surgical intervention.
Case Report (n=1)
Aortic dissection involving the carotid arteries can present as acute ischemic stroke, and careful evaluation is crucial before initiating fibrinolytic therapy.
Stroke presentations warrant aortic dissection exclusion before fibrinolysis; this case leaves open whether routine pre-treatment imaging should change practice.
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 takes yet. Share an insight, caveat, or question.
Deniz et al. (2014) conducted a case report in Aortic dissection (n=1). Surgical intervention was evaluated. Diagnostic imaging revealed an aortic dissection involving the carotid arteries in a 71-year-old woman presenting with acute stroke, changing the planned fibrinolytic therapy to surgical intervention.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: