Aortic dissection causing embolic stroke

Abstract

A 45-year-old female, known hypertensive for the past five years, presented with an episode of generalized seizure. She also had diffuse headache and mild retrosternal chest pain just few hours prior to the episode of unconsciousness. On examination, pulse was 68 min, normal rhythm, volume, character, and all peripheral pulses were well felt and blood pressure was 170/100 mmHg. Cardiac auscultation revealed early diastolic murmur in the right parasternal area. On neurological examination the deep tendon reflexes were exaggerated and plantar were bilaterally flexor, and tandem gait was ataxic. Diffusion-weighted magnetic resonance imaging (MRI) of brain revealed multiple small hyperintense lesions involving bilateral subcortical areas and cerebellar white matter, suggesting acute embolic infarcts [ Figure 1]. Transthoracic echo cardiogram revealed dilated ascending aorta and an intimal flap suggestive of dissection. MR aortogram confirmed the same, the dissection extending from ascending aorta till bifurcation of aorta [ Figure 2]. Her carotid and vertebral arteries were normal.