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• W2895092934 abstract "SESSION TITLE: Critical Care 2 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Ascending aortic dissection (AAD) typically presents with acute onset of thoracic or abdominal pain but pain free dissections occur in up to 15% of cases. This is further complicated by the fact that neurological symptoms mimicking a cerebrovascular accident (CVA) can be present in up to 40% of cases and can mask the underlying dissection. Thrombolysis as treatment for CVA without considering AAD can be detrimental to the patient’s health. We present a 77 year old female who received tPA for left sided hemiparesis later found to be secondary to a Sanford Type A aortic aneurysm. CASE PRESENTATION: A 77-year-old female with hypertension presented to the ED an hour after syncope with left sided hemiplegia. Per family, the symptoms were waxing and waning therefore she was brought into the ED for further management. En route the patient was hypotensive to 76/59 mmHg in the left arm and received IV fluids with improvement to 140 mmHg on initial presentation. Physical examination demonstrated bradycardic rate with no murmurs, and neurologic exam showed right gaze deviation, dysarthria, left sided facial droop and left hemiparesis. NIH stroke scale was 13 and CT head showed no hemorrhage. EKG showed sinus bradycardia and Chest x-ray was not performed. The patient was deemed a candidate for tPA therapy and became hypotensive to 60’s within 30 minutes of tPA administration. Additionally, she had decreased left sided pulses prompting a CTA of the head, neck and chest showing an AAD from the aortic valve to the common iliac arteries with bilateral common carotid dissections (Figure 1, 2). She was emergently taken to the OR and suffered a PEA arrest secondary to previously unseen cardiac tamponade requiring emergent evacuation. The patient unfortunately succumbed to her injury and was pronounced in the operating room. DISCUSSION: AAD is a vascular emergency typically presenting with chest and back pain but symptomatology is wide depending on the cardiovascular structures affected. Commonly patients present with sudden onset pain, pulse deficit with unequal blood pressures, and an aortic diastolic murmur. Isolated neurological symptoms present in ∼10% of AAD making history and physical exam crucial. Suggestive signs include syncope with signs of transient global amnesia or disturbances in consciousness with focal neurological signs in setting of shock-like appearance, cardiac murmur or asymmetrical pulses. Chest x-ray demonstrates widened mediastinum in 80% of cases. Carotid ultrasound has been suggested as noninvasive tool to detect carotid dissections but is not commonly employed. CONCLUSIONS: tPA as treatment for CVA is well established, but misdiagnosing AAD can lead to significant morbidity and mortality as it did with our patient. Our case highlights the importance of medical history and physical exam in patients with suspected CVA to reduce the risk of tPA associated complications in AAD. Reference #1: Villa A, Molgora M, Licari S, Omboni E. Acute ischemic stroke, aortic dissection, and thrombolytic therapy. Am J Emerg Med 2003;21:159–160. Reference #2: Takahashi Ch., Sasaki T.: Consideration of Two Cases of Ascending Aortic Dissection That Began with Stroke-Like Symptoms. Case Reports in Neurological Medicine 2015 DISCLOSURES: No relevant relationships by Ayushi Chauhan, source=Web Response No relevant relationships by Prashant Grover, source=Web Response No relevant relationships by Parin Shah, source=Web Response No relevant relationships by Aniket Sharma, source=Web Response" @default.
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• W2895092934 date "2018-10-01" @default.
• W2895092934 modified "2023-09-25" @default.
• W2895092934 title "ASCENDING AORTIC DISSECTION MASQUERADING AS AN ISCHEMIC CVA: A DIAGNOSTIC DILEMMA" @default.
• W2895092934 doi "https://doi.org/10.1016/j.chest.2018.08.317" @default.
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