title: Combined cardiac-neurosurgical treatment of acute aortic dissection, stroke, and coma.
abstract: Coma or stroke with secondary brain malperfusion is usually considered a strong contraindication for emergent surgical treatment of acute aortic dissection. Herein, we present the case of a 30-year-old woman who presented with sudden left hemiplegia and level-7 coma on the Glasgow Coma Scale. Transthoracic echocardiography showed type A aortic dissection. Although the patient was unable to communicate, her family approved an emergency Bentall operation. She regained consciousness but developed anisocoria and Glasgow Coma Scale level-4 coma 30 hours after the operation. Computed tomography showed massive cerebral infarction with hernia of the uncus gyri hippocampi. Emergency surgical cerebral decompression was performed. The patient survived; after 1 year, she had full mental acuity and minor left motor sequelae.
authors.affiliation: Department of Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, C.C. Iliescu Institute of Cardiovascular Diseases, 022328 Bucharest, Romania.
authors.forename: Vlad A
authors.initials: VA
authors.lastname: Iliescu
authors.forename: Lucian F
authors.initials: LF
authors.lastname: Dorobantu
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Stiru
authors.forename: Serban
authors.initials: S
authors.lastname: Bubenek
authors.forename: Ion
authors.initials: I
authors.lastname: Miclea
authors.forename: Mihaela
authors.initials: M
authors.lastname: Rugina
authors.forename: Cristian
authors.initials: C
authors.lastname: Boros
authors.forename: Serban
authors.initials: S
authors.lastname: Georgescu
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D003128:Coma / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*