Amr Gilles, Boulouis Gregoire, Bricout Nicolas, Modine Thomas, Fayad Georges, Aguettaz Pierre, Koussa Mohamad
Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, Lille, France.
Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Stroke Cerebrovasc Dis. 2016 May;25(5):1280-1283. doi: 10.1016/j.jstrokecerebrovasdis.2016.02.012. Epub 2016 Mar 7.
Acute stroke in the setting of acute type A aortic dissection is not rare and may contraindicate immediate surgery. Evaluating irreversible brain damage is critical in this setting and magnetic resonance imaging is a key determinant in the decision of selecting surgical over medical treatment for these patients.
We report herein 2 cases assessed at a tertiary care center for acute stroke. The initial diagnosis workup revealed cerebral hemispheric severe hypoperfusion without any brain infarction. The absence of ischemic lesions prompted surgical repair, despite the severity of clinical symptoms. Both patients demonstrated complete neurological recovery and neuroimaging showed no persistent sequel.
Acute type A aortic dissection is an important differential diagnosis in the causative workup for stroke. Brain hypoperfusion alone should not be a contraindication for urgent surgical treatment, regardless of initial clinical neurological severity.
急性A型主动脉夹层合并急性卒中并不罕见，可能成为立即手术的禁忌证。在这种情况下，评估不可逆性脑损伤至关重要，而磁共振成像对于决定这些患者选择手术治疗还是药物治疗起着关键作用。
我们在此报告2例在三级医疗中心评估的急性卒中病例。初始诊断检查显示大脑半球严重灌注不足，但无任何脑梗死。尽管临床症状严重，但缺血性病变的缺失促使进行手术修复。两名患者均实现了完全神经功能恢复，神经影像学检查未显示持续性后遗症。
急性A型主动脉夹层是卒中病因检查中的重要鉴别诊断。无论初始临床神经功能严重程度如何，单纯脑灌注不足不应成为紧急手术治疗的禁忌证。
