Aortic dissection masquerading as a code stroke: A single-centre cohort study
| Autor: | R. Nils Planken, Valeria Guglielmi, Abdullah Kaya, Hanna Talacua, Laura Posthuma, S. Matthijs Boekholdt, Adrien E. Groot, Nina-Suzanne Groeneveld, Jonathan M. Coutinho, Yvo B.W.E.M. Roos, Charles B. L. Majoie |
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| Přispěvatelé: | Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Pulmonary hypertension & thrombosis, Amsterdam Neuroscience - Neurovascular Disorders, Neurology, Radiology and Nuclear Medicine, Cardiothoracic Surgery, Cardiology, ACS - Heart failure & arrhythmias |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Aortic dissection
medicine.medical_specialty education.field_of_study ischaemic stroke business.industry Incidence (epidemiology) Population transient ischaemic attack medicine.disease stroke Single centre Internal medicine Original Research Articles Ischaemic stroke Cardiology Medicine Neurology (clinical) cardiovascular diseases Cardiology and Cardiovascular Medicine business education Stroke Cohort study |
| Zdroj: | European Stroke Journal European Stroke Journal, 5(1), 56-62. SAGE Publications Inc. |
| ISSN: | 2396-9881 2396-9873 |
| Popis: | Introduction Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre. Patients and methods We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke (‘code stroke’). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries. Results Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0–2). Discussion and Conclusion In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients. |
| Databáze: | OpenAIRE |
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