Three Cases of Stroke in Patients with Atypical Presentation of Type A Aortic Dissection – Potential of Neurosonography in the Early Diagnosis of Atypical Stroke

Introduction

Stroke is a rare manifestation of type A aortic dissections occurring in 17 – 30 % of patients (Collins J et al. [IRAD] Circulation 2004; 110: II-237–II-242; Gaul C et al. Stroke 2007; 38: 292 – 297). Over 85 % of patients with type A aortic dissections present with severe chest or back pain, are hypertensive at presentation (36 %), complain about abdominal pain (22 %) and show signs of aortic regurgitation (44 %) or pulse deficits (31 %). About a quarter of patients are found to be hypotensive (or in shock) adding to the high mortality of acute aortic dissections of 40 – 70 % within the first 48 hours, which underlines the importance of an early diagnosis (Meszaros I et al. Chest 2000; 117: 1271 – 1278). If the left common carotid artery (CCA) is involved, patients will often present with aphasia or agitation and thus are frequently difficult to assess with CT or MR angiography without sedation (Gaul C et al. Cerebrovascular Diseases 2008; 26: 1 – 8). We here report on three stroke patients, where emergency neurosonography of the extracranial arteries led to the diagnosis.