Kowalska-Brozda Olimpia, Brozda Mateusz
Department of Neurology, Ministry of Interior Hospital, Krakow, Poland.
Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland.
Neurol Neurochir Pol. 2015;49(3):197-202. doi: 10.1016/j.pjnns.2015.04.009. Epub 2015 May 6.
Acute aortic dissection is a rare, life-threatening condition requiring early recognition and proper treatment. Although chest pain remains the most frequent initial symptom, clinical manifestation of aortic dissection varies. Rarely aortic dissection starts with neurological symptoms such as ischemic stroke, which is usually right-sided. A danger of performing thrombolytic therapy in these patients exists if aortic dissection is overlooked. Herein, we present a case of a patient with acute aortic dissection without typical chest pain whose initial manifestation was bilateral stroke. The uncommon presentation which masked the underlying condition delayed implementation of appropriate management. Moreover, the late admission to hospital prevented the patient from administration of recombined tissue plasminogen activator that would certainly decrease chances of survival. Presented case highlights the need for thorough physical examination at admission to hospital in all patients with acute stroke and points out the necessity of proper clinical work-up including adequate aorta imaging modalities of patients with acute stroke and suggestive findings of aortic dissection.
急性主动脉夹层是一种罕见的、危及生命的疾病，需要早期识别和恰当治疗。尽管胸痛仍是最常见的初始症状，但主动脉夹层的临床表现各异。主动脉夹层很少以缺血性卒中之类的神经系统症状起病，缺血性卒中通常发生在右侧。如果忽视了主动脉夹层，对这些患者进行溶栓治疗存在风险。在此，我们报告一例急性主动脉夹层患者，其无典型胸痛，初始表现为双侧卒中。这种掩盖潜在病情的不常见表现延误了恰当治疗的实施。此外，患者入院较晚，无法给予重组组织型纤溶酶原激活剂，这肯定会降低生存几率。该病例强调了对所有急性卒中患者入院时进行全面体格检查的必要性，并指出对急性卒中和有主动脉夹层提示性表现的患者进行包括适当的主动脉成像检查在内的恰当临床检查的必要性。
