Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
Am J Emerg Med. 2013 Apr;31(4):762.e5-6. doi: 10.1016/j.ajem.2012.12.027. Epub 2013 Feb 8.
Early detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians, especially when under the stress of the 3-hour golden time window for thrombolytic therapy. We reported a 57-year-old man with acute right hemisphere watershed ischemic stroke caused by painless type A aortic dissection was diagnosed in time with computed tomographic (CT) angiography. The possible detrimental impact which may have been incurred by thrombolytic therapy was avoided. We suggest that cerebral CT angiography, covering from the aortic arch to intracranial arteries, should be performed in acute ischemic stroke patients, particularly in those with watershed CT perfusion deficits, to exclude the possibility of aortic dissection before thrombolytic treatment.
急性缺血性卒中继发于无痛性主动脉夹层，这对急诊医师来说是一个挑战，尤其是在溶栓治疗的 3 小时黄金时间窗口压力下。我们报告了一例 57 岁男性，因无痛性 A 型主动脉夹层引起的急性右半球分水岭缺血性卒中，及时通过计算机断层扫描（CT）血管造影进行了诊断。溶栓治疗可能造成的损害得以避免。我们建议对急性缺血性卒中患者进行脑 CT 血管造影，范围从主动脉弓到颅内动脉，特别是对那些有分水岭 CT 灌注缺损的患者，以排除溶栓治疗前主动脉夹层的可能性。
