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[Two cases of acute aortic disease complicated by ischemic cerebrovascular disease]
K Hayashi1, T Matsuo, M Kurihara
1Department of Neurosurgery, Juzenkai Hospital, Japan.
Insights
Acute aortic diseases, including dissection and aneurysm, can cause ischemic cerebrovascular disease (CVD). Prompt diagnosis and treatment are crucial for managing these rare but severe complications.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Ischemic cerebrovascular disease (CVD) is typically linked to atherosclerosis and cardiac emboli.
- Rarely, CVD can be associated with aortic conditions like Takayasu's arteritis, aortic dissection, and aneurysm.
Observation:
- Two cases of acute aortic disease complicated by ischemic CVD are presented.
- Case 1: A 77-year-old male with aortic dissection presenting with hemiparesis and dyspnea, successfully treated with aortic graft replacement.
- Case 2: A 67-year-old female with a ruptured abdominal aortic aneurysm presenting with hemiparesis and hypotension, who unfortunately died.
Findings:
- Aortic dissection and aneurysm can manifest as ischemic symptoms affecting multiple organs due to vascular compromise.
- The association between aortic dissection and ischemic CVD is uncommon, often requiring neurologist involvement.
- Acute aortic pathologies like dissection and aneurysm necessitate immediate diagnosis and intervention.
Implications:
- Highlights the importance of considering aortic pathology in patients presenting with ischemic CVD, especially in acute aortic disease.
- Emphasizes the critical need for rapid diagnosis and surgical management of aortic dissection and aneurysms to prevent catastrophic neurological and systemic events.
- Suggests a multidisciplinary approach involving neurologists and vascular surgeons for optimal patient outcomes.
Abstract:
Ischemic cerebrovascular diseases are commonly induced by atherosclerosis and cardiogenic embolization but rarely they occur in association with Takayasu's arteritis and aortic lesion such as aortic dissection and aneurysm. Here we experienced two cases of acute aortic disease complicated by ischemic cerebrovascular disease (CVD). Patient 1 was a 77-year-old male. He complained of dyspnea and left hemiparesis. He was brought to our hospital by ambulance. Left hemiparesis and dyspnea improved soon. The patient only complained of left lower extremity pain and physical examination revealed hypotension. Brain CT showed no abnormality but chest CT revealed aortic dissection. The resection of the intimal tear and replacement of ascending aorta and aortic arch with 28 mm Hemashield graft were performed under hypothermia and selective cerebral perfusion. The postoperative course was uneventful and he has been doing well. Patient 2 was a 67-year-old female. She was found lying unconscious and brought to our hospital by ambulance. Physical examination revealed right hemiparesis and hypotension. Brain CT demonstrated low density area in the left corona radiata and ruptured aortic aneurysm was seen in abdominal CT. Just after the examination, the patient suddenly complained of severe back pain and died despite cardiopulmonary resuscitation. Aortic lesions can manifest ischemic symptom involving multiple organs following their vascular disorder. Aortic dissection rarely occurs in association with ischemic CVD and in that case it is likely to be seen by neurologists. Aortic dissection and aneurysm deteriorate so suddenly that immediate diagnosis and proper treatment are needed.