Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2022; 10(22): 8009-8017
Published online Aug 6, 2022. doi: 10.12998/wjcc.v10.i22.8009
Acute ischemic Stroke combined with Stanford type A aortic dissection: A case report and literature review
Zhi-Yang He, Lin-Peng Yao, Xiao-Ke Wang, Nai-Yun Chen, Jun-Jie Zhao, Qian Zhou, Xiao-Feng Yang
Zhi-Yang He, Xiao-Ke Wang, Nai-Yun Chen, Qian Zhou, Xiao-Feng Yang, Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Lin-Peng Yao, Jun-Jie Zhao, Department of Radiology, The First Affiliated Hospital, Zhejiang University school of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: He ZY and Yao LP contributed equally to this case, both wrote and revised the text; Zhou Q and Yang XF contributed equally in this case report; all were part of the clinical team that treated the patient, and all contributed to the text.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No conflict of interests exists to any of the authors.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qian Zhou, MM, Attending Doctor, Department of Emergency and Trauma Center, The International Medical Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 1367 Wenyi West Road, Hangzhou 310003, Zhejiang Province, China. qianzhou1994@zju.edu.cn
Received: February 14, 2022
Peer-review started: February 14, 2022
First decision: April 8, 2022
Revised: April 11, 2022
Accepted: June 26, 2022
Article in press: June 26, 2022
Published online: August 6, 2022
Processing time: 157 Days and 21.8 Hours
Abstract
BACKGROUND

Acute aortic dissection (AAD) is a high mortality disease that can lead to acute ischemic strokes (AIS). Some of the patients with AAD combined with AIS initially present with neurological symptoms, which can easily lead to missed or delayed AAD diagnosis. This is attributed to the lack of physician awareness or the urgency of patient thrombolysis. Intravenous administration of thrombolytic therapy (IVT) for AAD is associated with poor prognostic outcomes. We report a patient with AIS combined with AAD who developed a massive cerebral infarction after receiving IVT for a missed AAD diagnosis.

CASE SUMMARY

A 49-year-old man was admitted to a local hospital with an acute onset of left-sided limb weakness accompanied by slurred speech. The patient had a history of hypertension that was not regularly treated with medication. Physical examination revealed incomplete mixed aphasia and left limb hemiparesis. Cranial computed tomography (CT) scan showed bilateral basal ganglia and lateral ventricular paraventricular infarct lesions. The patient was diagnosed with AIS and was administered with IVT. After IVT, patient’s muscle strength and consciousness deteriorated. From the local hospital, he was referred to our hospital for further treatment. Emergency head and neck CT angiography (CTA) scans were performed. Results showed multiple cerebral infarctions, and aortic dissection in the ascending aorta, innominate artery, as well as in the right common carotid artery. Then, the CTA of thoracoabdominal aorta was performed, which revealed a Stanford type A aortic dissection and aortic dissection extending from the aortic root to the left external iliac artery. Laceration was located in the lesser curvature of the aortic arch. AAD complicated with AIS was considered, and the patient was immediately subjected to cardiovascular surgery for treatment. The next day, the patient underwent aortic arch and ascending aortic replacement and aortic valvuloplasty.

CONCLUSION

Clinical manifestations for AAD combined with AIS are diverse. Some patients may not exhibit typical chest or back pains. Therefore, patients should be carefully evaluated to exclude AAD before administering IVT in order to avoid adverse consequences.

Keywords: Acute aortic dissection; Acute ischemic stroke; Intravenous thrombolysis; Ultrasound evaluation; Case report

Core Tip: Acute aortic dissection (AAD) is a high mortality condition that can lead to acute ischemic stroke (AIS). A patient was treated with thrombolytic therapy in a local hospital for AIS but his symptoms did not improve and progressed to a large cerebral infarction. The patient was eventually diagnosed with AAD. This is a rare case and we should rule out AAD before thrombolysis in patients with cerebral infarction.