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An extensive stanford type a aortic dissection involving bilateral carotid and iliac arteries

E W Lee1, N Jourabchi, S C Sauk

  • 1Department of Radiology, David Geffen School of Medicine, UCLA Health System, Los Angeles, CA 90095, USA ; Department of Family Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA.

Case Reports in Radiology
|February 13, 2013
PubMed

Insights

This case highlights extensive aortic dissection mimicking ischemic stroke. Prompt diagnosis is crucial, as thrombolytic therapy for stroke can worsen aortic dissection.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Diagnostic Imaging

Background:

  • Aortic dissection (AD) presents with diverse clinical manifestations.
  • Overlap in symptoms between AD and ischemic stroke can lead to misdiagnosis.
  • Thrombolytic therapy is indicated for ischemic stroke but contraindicated in AD.

Purpose of the Study:

  • To report a rare case of extensive aortic dissection involving bilateral common carotid arteries and the aorta.
  • To emphasize the importance of considering AD in patients presenting with stroke-like symptoms.
  • To underscore the critical difference in management between AD and ischemic stroke.

Main Methods:

  • Case presentation of a 61-year-old male with chronic hypertension presenting with chest pain and neurological deficits.
  • Initial diagnosis of presumed ischemic stroke treated with thrombolytic therapy.
  • Diagnostic imaging including Doppler ultrasound and CT angiography revealing extensive aortic dissection.

Main Results:

  • The patient exhibited continuous, extensive aortic dissection involving the aorta and bilateral common carotid arteries.
  • Initial thrombolytic therapy for presumed stroke led to temporary symptom resolution.
  • Subsequent cardiovascular surgery resulted in a positive clinical outcome.

Conclusions:

  • A high index of suspicion for aortic dissection is essential in patients with stroke-like presentations.
  • Distinguishing between aortic dissection and ischemic stroke is critical for appropriate and safe patient management.
  • Misdiagnosis and inappropriate treatment, such as thrombolysis in AD, can have detrimental consequences.

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