Chahine Johnny, Thapa Bicky, Gajulapalli Rama D, Kadri Amer
Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA.
Cureus. 2018 Oct 31;10(10):e3531. doi: 10.7759/cureus.3531.
Acute aortic dissection is a deadly disease that should be recognized promptly. We report an exceptional case of a 44-year-old African American female who presented with a rapidly progressing severe frontal headache. Initial computed tomography of the brain was negative. The following day, she developed uncontrolled hypertension and worsening headache. Magnetic resonance imaging of the brain was therefore done and showed evidence of acute/subacute ischemic infarcts. The patient was managed as having an ischemic stroke. For that reason, an echocardiogram was done the next day that showed a dilated aortic root and moderate-to-severe aortic regurgitation. This was followed by a computed tomography angiography which showed ascending aortic dissection involving bilateral common carotid arteries. After an urgent surgical intervention, the patient recovered without any sequelae. Patients with an acute dissection can present with atypical clinical features, such as an isolated rapidly progressive headache, which might delay the diagnosis and jeopardize their lives. Hence, high-risk patients with rapidly progressive unexplained severe headaches should be considered for imaging of the aorta.
急性主动脉夹层是一种应迅速识别的致命疾病。我们报告了一例特殊病例，一名44岁的非裔美国女性，出现快速进展的严重前额头痛。最初的脑部计算机断层扫描结果为阴性。第二天，她出现了难以控制的高血压和头痛加重。因此进行了脑部磁共振成像，显示有急性/亚急性缺血性梗死的迹象。该患者被当作缺血性中风进行治疗。出于这个原因，第二天做了超声心动图，显示主动脉根部扩张和中度至重度主动脉瓣反流。随后进行的计算机断层扫描血管造影显示升主动脉夹层累及双侧颈总动脉。经过紧急手术干预，患者康复且无任何后遗症。急性夹层患者可能表现出非典型临床特征，如孤立的快速进展性头痛，这可能会延迟诊断并危及生命。因此，对于有快速进展的不明原因严重头痛的高危患者，应考虑进行主动脉成像检查。
