Stanford Type A Debakey Type I Aortic Dissection Involving the Internal Carotid and Femoral Arteries Presenting as Left Middle Cerebral Artery Acute Ischemic Stroke

摘要

A 61-year-old man with past medical history of hypertension and tobacco use (but no other cardiac history) presented as a prehospital stroke activation after being found down by family with leftward eye gaze deviation, right-sided facial droop, aphasia, and right-sided hemiparesis without chest/back pain; National Institutes of Health Stroke Scale was found to be 25. Patient was hypertensive in the field but seen to have progressively decreasing blood pressure during the stroke activation time course. Screening laboratories were notable for elevated creatinine and troponin. Electrocardiogram showed T-wave inversions of the lateral leads. Computed tomography imaging revealed early ischemic changes in the left middle cerebral artery territory (Figure 1). Computed tomography angiography showed left internal carotid artery (ICA) occlusion and an extensive Stanford type A, Debakey type I aortic dissection involving the entirety of the thoracic and abdominal aorta with extension to the left ICA and right femoral artery (Figure 1). Prior to emergent vascular surgery, he had a convulsive seizure, followed by new ST-segment elevations on cardiac monitor, then pulseless electrical activity (PEA) arrest. Despite aggressive cardiopulmonary resuscitation, he was unable to be resuscitated. On autopsy, cardiac tamponade with over 1500 mL of fresh blood in the pericardial cavity was reported.