A Case of Late Diagnosis of Acute Aortic Dissection Involving the Carotid Arteries in a Patient Presenting with Signs of Acute Ischemic Stroke

Bressler, Moshe Y.; Klein, Elliot; Shayowitz, Michelle; Gupta, Kunal; Delman, Alex

doi:10.12659/ajcr.919271

Cited by 4 publications

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“…Similarly, when AAS masquerades as an ischaemic stroke, there may be inappropriate administration of thrombolysis. There were no such cases found in this case series, but Bressler et al 18 reported a case in 2020 and recommended that AAS should at least be considered prior to thrombolysis. Usui et al 19 suggested that CT to exclude aortic dissection should be part of stroke protocol for ischaemic stroke, after reporting a single case study.…”

Section: Discussionmentioning

confidence: 64%

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

et al. 2023

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Objectives: To understand why the diagnosis of AAS is missed in the ED, and to characterise the presenting features of cases in which a diagnosis of AAS was missed. Methods: A retrospective case series cohort study was performed, identifying and analysing cases where AAS was misdiagnosed in three UK EDs between 1st January 2011 and 31st December 2020. Results: 43 cases were included, 22 of which were type A aortic dissections. The most common incorrect presumed diagnoses made were acute coronary syndrome (28%), pulmonary embolism (12%) and ‘non-specific chest pain’ (12%). In 31 cases (72%) there was no evidence from the notes that the clinician had considered AAS in the differential diagnosis. In 10 cases (23%), AAS was considered, but the clinician was falsely reassured by atypical or resolved symptoms, clinical examination, or normal chest x-ray. Conclusions: ED clinicians may miss AAS by not considering it as a possibility, being falsely reassured by atypical or resolved symptoms, or mistaking it for other more common conditions. Further prospective work is necessary to establish the role of diagnostic aids and biomarkers in UK EDs.

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Section: Discussionmentioning

confidence: 64%

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

et al. 2023

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“…In situations where patients with neurological deficits do not trigger a "Code Stroke" activation and are not directly triaged to CT imaging suites, a portable anteroposterior (AP) chest X-ray should be obtained to quickly identify features such as a mediastinal widening and apical pleural capping that would prompt further investigation of possible AAD [14]. Clinicians should also perform a focused physical exam of all extremities, paying special attention to peripheral pulse quality, skin temperature, and blood pressure discrepancies that could indicate compromised arterial blood flow from propagating aortic dissection flaps [14].…”

Section: Discussionmentioning

confidence: 99%

Sudden Onset Hemiplegia and Neglect: A Case Report of Type A Aortic Dissection Presenting as a Code Stroke

et al. 2020

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“…Stanford type A aortic dissection (TAAD) is characterized by a sudden onset and high mortality (1). Currently, total aortic arch replacement (TAAR) is routinely performed using deep hypothermic circulatory arrest (DHCA) for the treatment of TAAD (2).…”

Section: Introductionmentioning

confidence: 99%

“…Multivariate analysis for CRRT[1] Lemeshow test χ 2 =5.592, P=0.693. CRRT, continuous renal replacement therapy; OR, odds ratio; CI, confidence interval.…”

mentioning

confidence: 99%

Risk factors of continuous renal replacement therapy following total aortic arch replacement under moderate hypothermia

Li¹,

Chen²,

Yao³

et al. 2021

Ann Transl Med

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Background: Stanford type A aortic dissection (TAAD) has a sudden onset and high mortality, and emergency total aortic arch replacement (TAAR) is the main treatment option for TAAD. The mortality rate of patients with postoperative acute kidney injury (AKI) combined with continuous renal replacement therapy (CRRT) is remarkable higher than that of patients without AKI. However, incidence of AKI and risk factors for CRRT following TAAR isn't entirely understood.Methods: From October 2018 to March 2021, all patients with Stanford type A dissection who underwent total arch replacement surgery under MHCA were enrolled. According to whether CRRT treatment was performed, participants were divided into a CRRT group (n=49) and control group (n=72). Both groups incorporated the brain protection strategy of moderate hypothermia, and the left common carotid artery and the innominate artery were perfused anteriorly. Relevant medical data was collected.Results: Age, gender, and a history of smoking and drinking were not significantly different between the 2 groups (P>0.1). There were statistical differences between the 2 groups in aortic sinus diameter and Bentall procedure (P≤0.05). Univariate analysis revealed that fresh frozen plasma was a protective factor (P<0.05) and the intraoperative transfusion volume of red blood cells, platelets, fresh frozen plasma, autologous blood used for intraoperative bleeding, aortic sinus diameter, and Bentall procedure were risk factors (P<0.1).Multivariate analysis showed that the Bentall procedure and intraoperative bleeding were risk factors for CRRT (P<0.05), and the aortic sinus diameter and intraoperative transfusion score were also risk factors for CRRT (P<0.05). Receiver operating characteristic (ROC) analysis demonstrated that the model of aortic sinus diameter and intraoperative transfusion score had more significantly different discriminatory powers. Conclusions:The Bentall procedure, intraoperative bleeding, aortic sinus diameter, and intraoperative transfusion score were risk factors for postoperative CRRT. The model of aortic sinus diameter and intraoperative transfusion score had more significantly different discriminatory powers.

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A Case of Late Diagnosis of Acute Aortic Dissection Involving the Carotid Arteries in a Patient Presenting with Signs of Acute Ischemic Stroke

Cited by 4 publications

References 0 publications

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

Why do emergency department clinicians miss acute aortic syndrome? A case series and descriptive analysis

Sudden Onset Hemiplegia and Neglect: A Case Report of Type A Aortic Dissection Presenting as a Code Stroke

Risk factors of continuous renal replacement therapy following total aortic arch replacement under moderate hypothermia

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