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学术急诊医学档案

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  3. 卷 13 编号 1 (2025): Continuous volume
  4. Case Report

卷 13 编号 1 (2025)

九月 2025

Stanford Type A Aortic Dissection Masquerading as Acute Ischemic Stroke: A Case Report

  • Chao Liu
  • Jiangrong Ma
  • Bo Zhang
  • Ji Xie
  • Liyu Lu
  • Shinan Nie

学术急诊医学档案, 卷 13 编号 1 (2025), 6 九月 2025 , 第 e18 页
https://doi.org/10.22037/aaemj.v13i1.2409 已出版: 2024-11-21

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摘要

Aortic dissection (AD), a life-threatening cardiovascular emergency, is characterized by the separation of the aorta’s inner and middle layers due to a tear in the intima. It is classified as Stanford type A or B based on the tear’s location and extent. Symptoms vary but commonly include severe pain in the chest, back, or abdomen, along with atypical presentations such as shock, heart failure, or syncope. End-organ ischemia, including stroke and limb necrosis, may occur. Timely diagnosis and intervention are crucial for survival. Here, we report a 31-year-old male patient who presented with acute neurological symptoms, initially suspected of having a stroke, but was ultimately diagnosed with Stanford type A AD upon computed tomography (CT) angiography. This case underscores the importance of considering AD in the differential diagnosis of patients with neurological symptoms for accurate and prompt management.

关键词:
  • Aortic dissection
  • ischemic stroke
  • Emergency Medicine
  • Computed Tomography Angiography
  • Case Reports
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Liu C, Ma J, Zhang B, Xie J, Lu L, Nie S. Stanford Type A Aortic Dissection Masquerading as Acute Ischemic Stroke: A Case Report. Arch Acad Emerg Med [网际网络]. 2024年11月21日 [见引于 2026年7月7日];13(1):e18. 载于: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/2409
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参考

Nienaber CA, Clough RE, Sakalihasan N, Suzuki T, Gibbs R, Mussa F, et al. Aortic dissection. Nat Rev Dis Primers. 2016;2:16053.

Gouveia EMR, Mourão M, Caldeira D, Alves M, Lopes A, Duarte A, et al. A systematic review and meta-analysis of the incidence of acute aortic dissections in population-based studies. J Vasc Surg. 2022;75(2):709-20.

Marroush TS, Boshara AR, Parvataneni KC, Takla R, Mesiha NA. Painless Aortic Dissection. Am J Med Sci. 2017;354(5):513-20.

Lovatt S, Wong CW, Schwarz K, Borovac JA, Lo T, Gunning M, et al. Misdiagnosis of aortic dissection: A systematic review of the literature. The American journal of emergency medicine. 2022;53:16-22.

Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological Symptoms in Type A Aortic Dissections. 2007;38(2):292-7.

Wang J, Wu LR, Xie X. Stanford type a aortic dissection with cerebral infarction: a rare case report. BMC neurology. 2020;20(1):253.

Pederson TG, Ahmed Y, Maddry JK, Kester NMJJoNR. Sudden onset hemiplegia and neglect: a case report of type A aortic dissection presenting as a code stroke. Journal of Neurology Research. 2020;10(6):248-52.

Tsivgoulis G, Kargiotis O, Alexandrov AV. Intravenous thrombolysis for acute ischemic stroke: a bridge between two centuries. Expert Rev Neurother. 2017;17(8):819-37.

Katsanos AH, Tsivgoulis G. Is intravenous thrombolysis still necessary in patients who undergo mechanical thrombectomy? Curr Opin Neurol. 2019;32(1):3-12.

Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, et al. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines. 2023;11(10):2617.

Uimonen M. Synthesis of multidimensional pathophysiological process leading to type A aortic dissection: a narrative review. J Thorac Dis. 2021;13(10):6026-36.

Zilber ZA, Boddu A, Malaisrie SC, Hoel AW, Mehta CK, Vassallo P, et al. Noninvasive Morphologic and Hemodynamic Evaluation of Type B Aortic Dissection: State of the Art and Future Perspectives. Radiol Cardiothorac Imaging. 2021;3(3):e200456.

Harris KM, Nienaber CA, Peterson MD, Woznicki EM, Braverman AC, Trimarchi S, et al. Early Mortality in Type A Acute Aortic Dissection: Insights From the International Registry of Acute Aortic Dissection. JAMA Cardiol. 2022;7(10):1009-15.

Malaisrie SC, Szeto WY, Halas M, Girardi LN, Coselli JS, Sundt TM, 3rd, et al. 2021 The American Association for Thoracic Surgery expert consensus document: Surgical treatment of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2021;162(3):735-58.e2.

Hong JC, Le Huu A, Preventza O. Medical or endovascular management of acute type B aortic dissection. J Thorac Cardiovasc Surg. 2022;164(4):1058-65.

Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type A aortic dissection. Circulation. 2013;128(11 Suppl 1):S175-9.

Ohara T, Koga M, Tokuda N, Tanaka E, Yokoyama H, Minatoya K, et al. Rapid Identification of Type A Aortic Dissection as a Cause of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2016;25(8):1901-6.

Yoshimuta T, Yokoyama H, Okajima T, Tanaka H, Toyoda K, Nagatsuka K, et al. Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke. Circ J. 2015;79(8):1841-5.

Um SW, Ohle R, Perry JJ. Bilateral blood pressure differential as a clinical marker for acute aortic dissection in the emergency department. Emerg Med J. 2018;35(9):556-8.

Tsivgoulis G, Vadikolias K, Heliopoulos I, Patousi A, Iordanidis A, Souftas V, et al. Aortic arch dissection causing acute cerebral ischemia: an uncommon contraindication for intravenous thrombolysis. Circulation. 2011;124(5):657-8.

Funakoshi H, Mizobe M, Homma Y, Nakashima Y, Takahashi J, Shiga T. The diagnostic accuracy of the mediastinal width on supine anteroposterior chest radiographs with nontraumatic Stanford type A acute aortic dissection. J Gen Fam Med. 2018;19(2):45-9.

Matsuo H. Clinical significance and impact of "painless" acute aortic dissection. Circ J. 2011;75(1):47-8.

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