Aortic Dissection Associated with Ischemic Stroke
Aortic dissection is defined as a rupture of the inner layer of the artery caused by intramural bleeding, resulting in separation of the aortic wall and subsequent formation of a true lumen and a false lumen with or without communication. The diagnosis is challenging, because of the nonspecific symptoms and the severe complications related to the disease, such as an encephalic vascular accident. In this article, we report the case of a male patient, 60 years old, a smoker, with controlled hypertension, who fell from a ladder, and who had symptoms of cold sweating and angina, evolving to a lower level of consciousness, dyslalia, left hemiplegia, and deviation of the labial commissure of mouth. With this information, propaedeutic investigations, such as computerized tomography of the skull, transthoracic echocardiography, and computerized tomographic angiography of the thoracic and abdominal aorta, were performed that identified an extensive ischemic stroke in a territory of the middle cerebral artery and a dissecting aneurysm of the ascending aorta (type A of the Stanford classification). Surgery of the exchange of the ascending aorta, correction of its arch, and a stent graft in the descending aorta was carried out. After a good postoperative evolution, the patient was discharged from hospital (with paresis of the left lower limb and plegia of the upper limb).
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