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Cardiothoracic Surgery |

Stanford Type A Aortic Dissection Onset With Neurological Symptoms: A Rare Case Report

Saniye Calik, MD; Ismail Aktas, MD; Mustafa Calik, MD; Basar Cander, MD
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Konya Education and Research Hospital, Konya, Turkey


Chest. 2015;148(4_MeetingAbstracts):29A. doi:10.1378/chest.2277709
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Abstract

SESSION TITLE: Cardiothoracic Surgery Global Case Reports

SESSION TYPE: Global Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Aortic dissection (AD) was first described in 1761, by Morgagni and occurs with the separation of the layers of the aortic wall.The intima and inner media are separated from the outer media and adventitia of the aorta to create a false lumen. AD whose incidence ranges from 5 to 30 cases per million people per year normally represents with acute thoracic or abdominal pain and concomitant cardiovascular symptoms.Even though pain and hypotension most frequently encountered clinical symptoms are wide and extremely variable. Neurological symptoms emerge due to hypotension, brain vessels occlusion and perfusion deficit [1, 2]. For 250 years after being notified by Morgagni AD is still associated with high mortality. Here in; we report a rare case of Stanford Type A Aortic Dissection (STAAD) onset with neurological symptoms.

CASE PRESENTATION: A 71-year-old male, who was transported to our emergency department by ambulance complaint of inability to recognize the environment, suddenly became non-verbal and had back pain. He was mild distress and confused at the admission. Physical examination was substantially unremarkable, with the exception of thready peripheral pulses and cold extremities. Initial computed tomography (CT) of the head showed no hemorrhage or areas of hypodensity. It was regarded as a normal by the attending radiologist. Acute stroke was determined in diffusion magnetic resonance imaging (MRI) but we thought that these complaints were not likely due to the stroke. The history and physical examination may strongly suggest AD that was suspected. Chest CT was performed and defined STAAD in the anterior arch of the aorta. He was taken immediately to operating room. Patient died because of ventricular fibrillation on second postoperative day.

DISCUSSION: AD occurs due to tearing in the inner wall of the aorta, which then causes blood to flow between layers of the muscular wall. Stroke occurs in one in twenty of patients with aortic dissection was associated with increased morbidity and in-hospital mortality, but not higher long-term mortality among survivors [3]. Neurological symptoms at the onset of AD are not only frequent (17-40%), but often dramatic and may mask underlying conditions [2].

CONCLUSIONS: Making the correct diagnosis could be difficult due to the rarity, wide range of symptoms and the similarity of other disease in emergency departments. Here, the essences of diagnosis are high level of suspicion in the patient with atypical signs and symptoms. Even though, relatively uncommon cause of stroke, AD should be kept in mind.

Reference #1: Karthikesalingam A, Holt PJ, Hinchliffe RJ, Thompson MM, Loftus IM. The diagnosis and management of aortic dissection. Vasc Endovascular Surg. 2010 Apr;44(3):165-9.

Reference #2: Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological Symptoms in Type A Aortic Dissections. Stroke. 2007 Feb;38(2):292-7.

Reference #3: Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, Ehrlich MP, Pyeritz RE, Steg PG, Greason K, Evangelista A, Kline-Rogers E,Montgomery DG, Isselbacher EM, Nienaber CA, Eagle KA Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013 Sep 10;128(11 Suppl 1):S175-9.

DISCLOSURE: The following authors have nothing to disclose: Saniye Calik, Ismail Aktas, Mustafa Calik, Basar Cander

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