Case Report
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Year 2020, Volume: 11 Issue: 2, 53 - 56, 09.10.2020
https://doi.org/10.33706/jemcr.699135

Abstract

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References

  • 1- Muhammed Ekmekyapar, Hakan Oğuztürk, Tuba Ekmekyapar, Serdar Derya, Şükrü Gürbüz, M. Gökhan Turtay. Aortic Dissection in Different Clinical Findings: Case Series. Eurasian J Critical Care 2019; 1 (1): 33-38.
  • 2- Mumcu S, Akgün M, Örken DN. Nörolojik Bozulma ile Baş Gösteren Aort Diseksiyonu Olguları Türk Nöroloji Dergisi. 2014; 20:51-3.
  • 3- Koç, S., Çetin, G., Kolusayın, Ö., Sarı, H.: Adli otopsilerde saptanan patolojik nitelikteki ölümler.1. Adli Bilimler Kongresi. Kongre kitabı. Adana.1994: 242-244.
  • 4- Çetin Kürşad Akpınar, Hakan Doğru. İskemik İnme İle Prezente Olan Aort Diseksiyonu: Olgu Sunumu. Turkish Journal of Cerebrovascular Diseases 2015; 21 (3): 200-203.
  • 5- Rampoldi V, Trimarchi S, Eagle KA, et al. International Registry of Acute Aortic Dissection (IRAD) Investigators. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg 2007; 83: 55–61.
  • 6- Suzuki T, Mehta RH, Ince H, et al. International Registry of Aortic Dissection (IRAD). Clinical profiles and outcomes of acute type B aortic dissection in the currentera: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003;108 (suppl 1): II312–17.
  • 7- Collins JS, Evangelista A, Nienaber CA, et al. International Registry of Acute Aortic Dissection (IRAD). Differences in clinical presentation, management, andoutcomes of acute type a aortic dissection in patients with and without previous cardiac surgery. Circulation 2004; 110 (suppl 1): II237–42.
  • 8- Tuna H, İzgi A Karadağ A, Yıldız M, Kokino S. Akut aort anevrizma diseksiyonu sonrası gelişen parapleji: Bir olgu sunumu. Türk Fiz Tıp Reh Der 2004;50:54-5.
  • 9- Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, Di Bartolomeo R, Folesani G, Pyeritz RE, Braverman AC, Montgomery DG, Isselbacher EM, Nienaber CA, Eagle KA, Fattori R. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2013;145:3 85-90.

UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE

Year 2020, Volume: 11 Issue: 2, 53 - 56, 09.10.2020
https://doi.org/10.33706/jemcr.699135

Abstract

Introduction: Both acute aorta dissection and ruptured aorta aneurism are prominent causes of death in cardiovascular diseases. The frequency of developing neurological complications in aortic dissections is reported to be between 2 to 8%. Stroke is more common in dissections involving the proximal aorta, but paraparesis is more common in distal aortic dissections due to circulatory impairment in the spinal arteries.
Case: The 70-year-old male patient was referred to our emergency service from an external center with diagnosis of acute ischemic stroke. The patient had experienced loss of strength on his left side and had syncope one hour before. After his physical examination, the patient received computerized brain tomography and diffusion MR imaging with the pre-diagnosis of acute stroke. For the patient who had an appearance of acute diffusion restriction in the right parietal region in the diffusion MRI and had a chance of thrombolytic treatment, thrombolytic treatment was planned. However, the general status of the patient was worsened in this checkup examination, and his GCS score regressed down to 7. The poor current condition of the patient could not be explained by the acute ischemic stroke in the right parietal region. Aorta dissection, which may progress with clinical signs of stroke, was considered for the patient, and as an advanced test, dynamic thorax CT angiography was taken. In the dynamic thorax CT angiography of the patient, aneurism in the ascending aorta, dissection and fluid around the pericardium and left lung (hemorrhage?) were observed. The echocardiography of the patient revealed that the fluid around the pericardium caused tamponade.
Discussion: Cardiovascular system diseases are the most common cause of natural sudden deaths and are mostly seen in middle and older ages. Acute myocardial infarction and coronary artery disease are the most common cardiovascular diseases, however, sudden deaths due to aortic dissection and rupture have been reported less frequently. The most typical symptom is the sudden start of severe chest or back pain. Patients typically visit with complaints of tearing chest and back pain, while they may visit with atypical clinical pictures wementioned in our cases such as abdominal pain, syncope, stroke. Sensory loss may also be seen in patients, and this is a neurological symptom which may extend from falling as leep to deep coma.
Conclusion: Patients who visit emergency services with symptoms that are not expected for aorta dissection such as syncope, altered consciousness, hypotension, atypical abdominal pain and loss of strength in the extremities.

References

  • 1- Muhammed Ekmekyapar, Hakan Oğuztürk, Tuba Ekmekyapar, Serdar Derya, Şükrü Gürbüz, M. Gökhan Turtay. Aortic Dissection in Different Clinical Findings: Case Series. Eurasian J Critical Care 2019; 1 (1): 33-38.
  • 2- Mumcu S, Akgün M, Örken DN. Nörolojik Bozulma ile Baş Gösteren Aort Diseksiyonu Olguları Türk Nöroloji Dergisi. 2014; 20:51-3.
  • 3- Koç, S., Çetin, G., Kolusayın, Ö., Sarı, H.: Adli otopsilerde saptanan patolojik nitelikteki ölümler.1. Adli Bilimler Kongresi. Kongre kitabı. Adana.1994: 242-244.
  • 4- Çetin Kürşad Akpınar, Hakan Doğru. İskemik İnme İle Prezente Olan Aort Diseksiyonu: Olgu Sunumu. Turkish Journal of Cerebrovascular Diseases 2015; 21 (3): 200-203.
  • 5- Rampoldi V, Trimarchi S, Eagle KA, et al. International Registry of Acute Aortic Dissection (IRAD) Investigators. Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score. Ann Thorac Surg 2007; 83: 55–61.
  • 6- Suzuki T, Mehta RH, Ince H, et al. International Registry of Aortic Dissection (IRAD). Clinical profiles and outcomes of acute type B aortic dissection in the currentera: lessons from the International Registry of Aortic Dissection (IRAD). Circulation 2003;108 (suppl 1): II312–17.
  • 7- Collins JS, Evangelista A, Nienaber CA, et al. International Registry of Acute Aortic Dissection (IRAD). Differences in clinical presentation, management, andoutcomes of acute type a aortic dissection in patients with and without previous cardiac surgery. Circulation 2004; 110 (suppl 1): II237–42.
  • 8- Tuna H, İzgi A Karadağ A, Yıldız M, Kokino S. Akut aort anevrizma diseksiyonu sonrası gelişen parapleji: Bir olgu sunumu. Türk Fiz Tıp Reh Der 2004;50:54-5.
  • 9- Di Eusanio M, Trimarchi S, Patel HJ, Hutchison S, Suzuki T, Peterson MD, Di Bartolomeo R, Folesani G, Pyeritz RE, Braverman AC, Montgomery DG, Isselbacher EM, Nienaber CA, Eagle KA, Fattori R. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg. 2013;145:3 85-90.
There are 9 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Report
Authors

Tuba Ekmekyapar 0000-0002-4814-8915

Muhammed Ekmekyapar 0000-0001-7008-2695

Şükrü Gürbüz 0000-0003-2616-0304

Hakan Oğuztürk 0000-0002-9800-1428

Publication Date October 9, 2020
Submission Date March 5, 2020
Published in Issue Year 2020 Volume: 11 Issue: 2

Cite

APA Ekmekyapar, T., Ekmekyapar, M., Gürbüz, Ş., Oğuztürk, H. (2020). UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE. Journal of Emergency Medicine Case Reports, 11(2), 53-56. https://doi.org/10.33706/jemcr.699135
AMA Ekmekyapar T, Ekmekyapar M, Gürbüz Ş, Oğuztürk H. UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE. Journal of Emergency Medicine Case Reports. October 2020;11(2):53-56. doi:10.33706/jemcr.699135
Chicago Ekmekyapar, Tuba, Muhammed Ekmekyapar, Şükrü Gürbüz, and Hakan Oğuztürk. “UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE”. Journal of Emergency Medicine Case Reports 11, no. 2 (October 2020): 53-56. https://doi.org/10.33706/jemcr.699135.
EndNote Ekmekyapar T, Ekmekyapar M, Gürbüz Ş, Oğuztürk H (October 1, 2020) UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE. Journal of Emergency Medicine Case Reports 11 2 53–56.
IEEE T. Ekmekyapar, M. Ekmekyapar, Ş. Gürbüz, and H. Oğuztürk, “UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE”, Journal of Emergency Medicine Case Reports, vol. 11, no. 2, pp. 53–56, 2020, doi: 10.33706/jemcr.699135.
ISNAD Ekmekyapar, Tuba et al. “UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE”. Journal of Emergency Medicine Case Reports 11/2 (October 2020), 53-56. https://doi.org/10.33706/jemcr.699135.
JAMA Ekmekyapar T, Ekmekyapar M, Gürbüz Ş, Oğuztürk H. UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE. Journal of Emergency Medicine Case Reports. 2020;11:53–56.
MLA Ekmekyapar, Tuba et al. “UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE”. Journal of Emergency Medicine Case Reports, vol. 11, no. 2, 2020, pp. 53-56, doi:10.33706/jemcr.699135.
Vancouver Ekmekyapar T, Ekmekyapar M, Gürbüz Ş, Oğuztürk H. UNEXPECTED ACUTE AORTA DISSECTION WITH ISCHEMIC STROKE. Journal of Emergency Medicine Case Reports. 2020;11(2):53-6.