Lantos Judit, Nagy Albert, Hegedűs Zoltán, Bihari Katalin
Bács-Kiskun Megyei Kórház, Neurológiai és Stroke Osztály, Kecskemét.
Bács-Kiskun Megyei Kórház, Intenzív Therapiás Osztály, Kecskemét.
Ideggyogy Sz. 2017 Jan 30;70(1-2):69-72. doi: 10.18071/isz.70.0069.
Seldom, an acute aortic dissection can be the etiology of an acute ischemic stroke. The aortic dissection typically presents with severe chest pain, but in pain-free dissection, which ranges between 5-15% of the case, the neurological symptoms can obscure the sypmtos of the dissection. By the statistical data, there are 15-20 similar cases in Hungary in a year. In this study we present the case history of an acute ischemic stroke caused by aortic dissection, which is the first hungarian publication in this topic. A 59-year-old man was addmitted with right-gaze-deviation, acute left-sided weakness, left central facial palsy and dysarthric speech. An acute right side ischemic stroke was diagnosed by physical examination without syptoms of acute aortic dissection. Because, according to the protocol it was not contraindicated, a systemic intravenous thrombolysis was performed. The neurological sypmtoms disappeared and there were no complication or hypodensity on the brain computed tomography (CT). 36 hours after the thrombolysis, the patient become restlessness and hypoxic with back pain, without neurological abnormality. A chest CT was performed because of the suspition of the aortic dissection, and a Stanford-A type dissection was verified. After the acute aortic arch reconstruction the patient died, but there was no bleeding complication at the dissection site caused by the thrombolysis. This case report draws attention to the fact that aortic dissection can cause acute ischemic stroke. Although it is difficult to prove it retrospectively, we think the aortic dissection, without causing any symptoms or complain, had already been present before the stroke. In our opinion both the history of our patient and literature reviews confirms that in acute stroke the thrombolysis had no complication effect on the aortic dissection but ceased the neurological symptoms. If the dissection had been diagnosed before the thrombolysis, the aortic arch reconstruction would have been the first step of the treatment, without thrombolysis.
急性主动脉夹层很少会成为急性缺血性卒中的病因。主动脉夹层通常表现为严重胸痛，但在无疼痛的夹层中（占病例的5 - 15%），神经症状可能会掩盖夹层症状。根据统计数据，匈牙利每年有15 - 20例类似病例。在本研究中，我们呈现了一例由主动脉夹层引起的急性缺血性卒中的病例史，这是匈牙利在该主题上的首次发表。一名59岁男性因右凝视偏斜、急性左侧肢体无力、左侧中枢性面瘫和构音障碍入院。经体格检查诊断为急性右侧缺血性卒中，无急性主动脉夹层症状。由于按照方案进行全身静脉溶栓无禁忌，遂进行了溶栓治疗。神经症状消失，脑部计算机断层扫描（CT）未发现并发症或低密度影。溶栓36小时后，患者出现躁动、缺氧伴背痛，无神经功能异常。因怀疑主动脉夹层进行了胸部CT检查，证实为斯坦福A型夹层。急性主动脉弓重建术后患者死亡，但溶栓未导致夹层部位出血并发症。本病例报告提醒人们注意主动脉夹层可导致急性缺血性卒中这一事实。虽然很难通过回顾性研究证实，但我们认为在卒中发生前主动脉夹层就已存在，只是未引起任何症状或主诉。我们认为患者的病史及文献综述均证实，在急性卒中中，溶栓对主动脉夹层无并发症影响，但缓解了神经症状。如果在溶栓前诊断出夹层，治疗的第一步应该是进行主动脉弓重建，而不进行溶栓。
