Consideration of two cases of ascending aortic dissection that began with stroke-like symptoms.

Chiaki Takahashi,Takashi Sasaki

doi:10.1155/2015/829756

Abstract

We recently experienced two patients with stroke-like symptoms and ascending aortic dissection (AAD) in our outpatient department. Both patients were transferred to our hospital presenting with neurological deficit such as hemiparesis and conjugate deviation. They did not complain from any chest or abdominal pain. Their MRI did not show fresh infarction or main branch occlusion. A chest CT image showed AAD. The former patient was immediately transferred to a tertiary hospital and the latter received conservative management in the cardiovascular department. Discussion. As neither patient was experiencing any pain, we initially diagnosed them with ischemic stroke and began treatment. Fortunately, bleeding complications did not occur. In such cases, problems are caused when intravenous tissue plasminogen activator (t-PA) injection is administered with the aim of reopening the occluded intracranial arteries. In fact, patients with AAD undergoing t-PA injection have been reported to die from bleeding complications without any recognition of the dissection. These findings suggest that confirmation using carotid ultrasound, carotid MR angiography, and a D-dimer test is crucial and should be adopted in emergency departments.

Highlights

In our emergency department (ED) and outpatient department, when we encounter patients with hyperacute strokelike symptoms such as hemiparesis, aphasia, and conjugate deviation of the eyes, we first assess whether intravenous tissue plasminogen activator (t-PA) injection can be used as a treatment
We considered that two possible causes were involved in these symptoms
In the second one of these studies, the patients with normal or low blood pressure made up more than 60% of all patients with type A dissection, while more than 70% of patients with type B dissection presented with a high BP of over 170 mmHg [3]

Summary

Introduction

In our emergency department (ED) and outpatient department, when we encounter patients with hyperacute strokelike symptoms such as hemiparesis, aphasia, and conjugate deviation of the eyes, we first assess whether intravenous tissue plasminogen activator (t-PA) injection can be used as a treatment. We perform a head computed tomography (CT) scan, blood test, chest X-ray, evaluation of NIH Stroke Scale (NIHSS), and electrocardiogram (ECG) test. We determine whether intravenous t-PA injection is indicated based on these results and check the items defined by The 2009 Japanese Guideline for the Management of Stroke. There are a small number of patients who show such stroke-like symptoms due to ascending aortic dissection (AAD) rather than intracranial artery occlusion. T-PA injection is contraindicated in cases of AAD. We recently experienced two such patients within a short period of time, and we report their cases

Case 1

Case 2

Findings

Discussion