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Aortic dissection masquerading as a code stroke: A single-centre cohort study.

Valeria Guglielmi1, Nina-Suzanne Groeneveld1, Laura Posthuma1

  • 1Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

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|April 2, 2020
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Summary
This summary is machine-generated.

Acute aortic dissection occurs in about 1 in 200 code stroke patients. This study highlights the importance of imaging the entire aortic arch in stroke patients to avoid missing this critical diagnosis.

Keywords:
Aortic dissectionischaemic strokestroketransient ischaemic attack

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Radiology

Background:

  • Limited data exists on acute aortic dissection incidence within the code stroke population.
  • This study investigates acute aortic dissection in patients presenting with stroke-like symptoms.

Purpose of the Study:

  • To estimate the incidence, clinical features, treatment, and outcomes of acute aortic dissection in a code stroke cohort.
  • To emphasize the diagnostic importance of aortic arch imaging in stroke evaluations.

Main Methods:

  • A prospective registry of adult patients with code stroke symptoms (2015-2018) was analyzed.
  • All patients underwent brain CT and CT angiography of the aortic arch, cervical, and intracranial arteries.

Main Results:

  • Fifteen patients (0.5% of code stroke patients) had acute aortic dissection (Stanford type A).
  • Common symptoms included decreased consciousness (73%), pain (53%), and hypotension (mean 106 mmHg).
  • Mortality was high (67%), though 60% of survivors had good functional outcomes.

Conclusions:

  • Approximately 1 in 200 code stroke patients and 1 in 125 acute ischemia patients experienced acute aortic dissection.
  • Multicenter studies are needed for a more accurate incidence estimate.
  • Routine imaging of the entire aortic arch is crucial for early diagnosis and management.