Jachińska Katarzyna, Lipczyńska-Łojkowska Wanda, Kuran Włodzimierz, Rozenfeld Anna, Grochowska Elzbieta, Szpak Grazyna M, Lenart Janusz
I Klinika Neurologiczna, Instytut Psychiatrii i Neurologii w Warszawie, ul. Sobieskiego 9, 02-957 Warszawa.
Neurol Neurochir Pol. 2009 Nov-Dec;43(6):584-90.
We present a case of a 62-year-old man who was admitted in grave condition to the Institute of Psychiatry and Neurology because of ischaemic stroke. Neurological examination re- vealed left-sided pyramidal hemiparesis. Computed tomography (CT) showed the ischaemic focus in the right cerebral hemisphere. Clinical examination and ultrasound examination revealed dissection of the aortic arch and extracranial arteries. Aortic dissection was confirmed in echocardiography and chest CT. The patient remained comatose and died after 7 days. Post-mortem examination identified dissection of the aortic arch, brachiocephalic truncus, common carotid arteries, internal carotid arteries and dissection extending along the whole aorta into both iliac arteries. This examination also showed a massive haemopericardium and a scar in the heart muscle after myocardial infarction. Microscopic examination identified cystic medial necrosis. This type of dissection is very rarely described.
我们报告一例62岁男性患者，因缺血性中风病情严重被收治于精神神经研究所。神经系统检查发现左侧锥体束偏瘫。计算机断层扫描（CT）显示右侧大脑半球有缺血灶。临床检查和超声检查发现主动脉弓和颅外动脉夹层。超声心动图和胸部CT证实为主动脉夹层。患者一直昏迷，7天后死亡。尸检发现主动脉弓、头臂干、颈总动脉、颈内动脉夹层，且夹层沿整个主动脉延伸至双侧髂动脉。该检查还显示大量心包积血以及心肌梗死后心肌的瘢痕。显微镜检查发现囊性中膜坏死。这种类型的夹层非常罕见。
