UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE

Abstract

Introduction: Both acute aorta dissection and ruptured aorta aneurism are prominent causes of death in cardiovascular diseases. The frequency of developing neurological complications in aortic dissections is reported to be between 2 to 8%. Stroke is more common in dissections involving the proximal aorta, but paraparesis is more common in distal aortic dissections due to circulatory impairment in the spinal arteries. Case: The 70-year-old male patient was referred to our emergency service from an external center with diagnosis of acute ischemic stroke. The patient had experienced loss of strength on his left side and had syncope one hour before. After his physical examination, the patient received computerized brain tomography and diffusion MR imaging with the pre-diagnosis of acute stroke. For the patient who had an appearance of acute diffusion restriction in the right parietal region in the diffusion MRI and had a chance of thrombolytic treatment, thrombolytic treatment was planned. However, the general status of the patient was worsened in this checkup examination, and his GCS score regressed down to 7. The poor current condition of the patient could not be explained by the acute ischemic stroke in the right parietal region. Aorta dissection, which may progress with clinical signs of stroke, was considered for the patient, and as an advanced test, dynamic thorax CT angiography was taken. In the dynamic thorax CT angiography of the patient, aneurism in the ascending aorta, dissection and fluid around the pericardium and left lung (hemorrhage?) were observed. The echocardiography of the patient revealed that the fluid around the pericardium caused tamponade. Discussion: Cardiovascular system diseases are the most common cause of natural sudden deaths and are mostly seen in middle and older ages. Acute myocardial infarction and coronary artery disease are the most common cardiovascular diseases, however, sudden deaths due to aortic dissection and rupture have been reported less frequently. The most typical symptom is the sudden start of severe chest or back pain. Patients typically visit with complaints of tearing chest and back pain, while they may visit with atypical clinical pictures wementioned in our cases such as abdominal pain, syncope, stroke. Sensory loss may also be seen in patients, and this is a neurological symptom which may extend from falling as leep to deep coma. Conclusion: Patients who visit emergency services with symptoms that are not expected for aorta dissection such as syncope, altered consciousness, hypotension, atypical abdominal pain and loss of strength in the extremities.