Cor Vasa 2002, 43(3):143-146

Aortic dissection-a less frequent cause of ischemic stroke. A case report and a review of the literature

Bohdan Křupka^1,*, Alice Hlobilková², Jan Galuszka³, Vlastislava Tichá², Roman Herzig¹, Ivanka Vlachová¹

¹ Iktové centrum Neurologické kliniky

² Ústav patologické anatomie

³ I. interní klinika, Fakultní nemocnice a lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

Ischemic stroke is the third most frequent cause of death in this country. A variety of conditions treated by internists and cardiologists manifest themselves by symptoms related to nervous system impairment. With aortic dissection, this is so in some 20-30% of cases, with ischemic stroke or hypoxic encephalopathy being the most frequent manifestations. The authors report the case of a 46-year-old man with a history of arterial hypertension, transferred to our department with symptoms of acute right-side supratentorial stroke. Subsequent examination (carotid duplex ultrasound, chest x-ray, transthoracic echocardiography and computed tomography with contrast medium injection) revealed extensive and inoperable thoracic and abdominal aortic dissection propagating into the brachioencephalic trunk, right common carotid artery, and both iliac arteries. The patient died from cardiac tamponade and massive pulmonary embolism after a 4-day stay at the department of anesthesiology/resuscitation. Autopsy revealed Erdheim cystic medionecrosis of the aorta.
Theoretically, the patient was fully eligible for thrombolytic therapy, yet other examinations performed over a very short period of time established a diagnosis making thrombolytic use a contraindication. It may thus be useful to consider expanding the diagnostic algorithm to include other methods when indicating intravenous thrombolysis in ischemic stroke patients.

Keywords: Ischemic stroke; Aortic dissection; Erdheim cystic medionecrosis

Published: March 1, 2002  Show citation