05 March 2020 : Case report
A Case of Late Diagnosis of Acute Aortic Dissection Involving the Carotid Arteries in a Patient Presenting with Signs of Acute Ischemic Stroke
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Educational Purpose (only if useful for a systematic review or synthesis)Moshe Bressler12ABEF*, Elliot Klein1EF, Michelle Shayowitz1AE, Kunal Gupta2AE, Alex Delman3A
Am J Case Rep 2020; 21:e919271
BACKGROUND: Acute aortic dissection (AAD) is a rare but life-threatening condition with high mortality. The Stanford classification of aortic dissection includes type A, which originates in the ascending aorta, and type B, which originates in the descending aorta. The diagnosis may be missed due to its ability to mimic other more common cardiovascular conditions. A case is presented of late diagnosis of AAD involving the right carotid arteries in a 55-year-old man who presented with acute ischemic stroke.
CASE REPORT: A 55-year-old man presented with sudden onset of left-sided facial weakness and aphasia. He was diagnosed with acute ischemic stroke and treated with tissue plasminogen activator. Further imaging showed an AAD involving the entire length of the aorta. Treatment with tissue plasminogen activator was discontinued, and the patient underwent surgical repair of the aorta. His hospital stay was complicated by acute kidney injury (AKI), pneumonia, and sepsis, and he died three weeks later from renal failure.
CONCLUSIONS: This case demonstrated that AAD can be challenging to diagnose, and may present atypically with ischemic stroke when it involves the carotid arteries. In such cases, imaging studies of the chest, abdomen, and head and neck may identify AAD and prevent inappropriate treatment with anticoagulants.
Keywords: Aneurysm, Dissecting, Diagnostic Errors, Hypertension, Stroke, Tissue Plasminogen Activator, Vertebral Artery Dissection, Aphasia, Carotid Artery Diseases, delayed diagnosis, Fatal Outcome, Middle Aged
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