Coexisting Type A and B Aortic Dissection with Extension to Carotid Arteries Resulting in Acute Ischemic Stroke

Authors

Dung Nguyen, HCA HealthcareFollow
Jilpa Shah, HCA HealthcareFollow
Amnah Andrabi

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Internal Medicine

Document Type

Poster

Publication Date

2025

Keywords

aortic dissection, stroke, AAD

Disciplines

Cardiovascular Diseases | Internal Medicine | Medicine and Health Sciences | Nervous System Diseases

Abstract

Coexisting Type A and B aortic dissection with extension to carotid arteries resulting in acute ischemic stroke Abstract Background: Acute aortic dissection (AAD) is a rare cause of ischemic stroke. Additionally, it is even rarer to have a combined type A and type B aortic dissection. ADD is a high-mortality disease that can lead to immediate decompensation and can be masked by stroke-like symptoms, which can result in delayed or missed diagnosis. We report a patient with acute ischemic stroke (AIS) with subsequent combined type A and type B aortic dissection. Case Report: A 47-year-old man was admitted to the hospital for nonspecific chest discomfort with associated symptoms of nausea and vomiting. The patient had a long history of uncontrolled hypertension (HTN) and stage IV chronic kidney disease (CKD) due to poor adherence to medications and previous history of pulmonary embolism. The initial physical assessment was unremarkable. Initially, high sensitivity troponin I levels were 72 with an upward trend to 191. B-type natriuretic peptide (BNP) was 32.8. Lipase was 28. Creatinine and blood urea nitrogen (BUN) were 5.01 and 36. D-dimer was 40181. Electrocardiogram (EKG) showed normal sinus rhythm with nonspecific ST changes in the inferior leads 2 and aVF and precordial leads. Given the medical history of CKD, a lung ventilation/perfusion scan (V/Q scan) showed a low probability of pulmonary emboli (PE). The next day, the rapid response team (code RRT) was called. The patient was found to have seizure-like activity and right-sided weakness. Brain attack magnetic resonance image (MRI), MRA head and neck, and CTA neck and aortic dissection were evaluated. Results were significant for acute infarcts in the left posterior frontal lobe cortex and right cerebellum with type A and B aortic dissection extending from the aortic root to the pericardium left common carotid and common femoral arteries. Acute aortic dissection (AAD) complicated with acute ischemic stroke (AIS) was considered, thrombolytics were withheld, and the patient was transferred to a specialized heart center for emergent cardiovascular surgical treatment. Conclusion: Initial ADD diagnosis can be missed in clinically stable patients lacking the typical tearing chest pain and back pain; subsequently, neurological symptoms can, in rare cases, mask an underlying AAD. This case highlights the need for clinicians to consider AAD in the differential diagnosis of acute ischemic stroke, particularly in patients with elevated D-dimer levels and risk factors such as hypertension and chronic kidney disease.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Nguyen, Dung; Shah, Jilpa; and Andrabi, Amnah, "Coexisting Type A and B Aortic Dissection with Extension to Carotid Arteries Resulting in Acute Ischemic Stroke" (2025). North Texas Research Forum 2025. 53.
https://scholarlycommons.hcahealthcare.com/northtexas2025/53