Deniz Turgut, Dag Ersel, Tulmac Murat, Azapoglu Burcu, Alp Caglar
Department of Emergency Medicine, Faculty of Medicine, Kirikkale University, 71350 Kirikkale, Turkey.
Department of Neurology, Faculty of Medicine, Kirikkale University, 71350 Kirikkale, Turkey.
Case Rep Emerg Med. 2014;2014:468295. doi: 10.1155/2014/468295. Epub 2014 Dec 2.
Introduction. Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI) of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT) angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.
引言。一些主动脉夹层（AD）病例可能会出现疼痛以外的各种症状，尤其是神经和心血管表现。累及颈动脉的AD可能与多种临床表现相关，从中风到非特异性头痛不等。病例报告。一名71岁女性因眩晕入院急诊，眩晕在前一小时内开始，并在言语障碍后意识恶化。到达时，她神志不清且不合作。脑部弥散磁共振成像（MRI）与大脑半球急性缺血相符。由于症状在两小时内出现，已计划进行溶栓治疗。超声心动图显示升主动脉扩张，怀疑有瓣片。已进行计算机断层扫描（CT）血管造影，检测到内膜瓣，与主动脉夹层相符，其壁内血肿从主动脉弓延伸至双侧颈总动脉。此后，治疗策略完全改变，进行了手术干预。结论。对于因意识丧失和中风入院急诊的患者，应牢记问诊不充分以及主动脉夹层累及颈动脉的情况。
