Combined cardiac-neurosurgical treatment of acute aortic dissection, stroke, and coma.
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.
Iliescu
Vlad A
VA
Department of Cardiovascular Surgery, University of Medicine and Pharmacy Carol Davila, C.C. Iliescu Institute of Cardiovascular Diseases, 022328 Bucharest, Romania.
Dorobantu
Lucian F
LF
Stiru
Ovidiu
O
Bubenek
Serban
S
Miclea
Ion
I
Rugina
Mihaela
M
Boros
Cristian
C
Georgescu
Serban
S
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*