title: Stroke Presentation of Acute Type A Aortic Dissection with 100% Perfusion-Weighted Imaging-Diffusion-Weighted Imaging Mismatch: A Call for Urgent Action.
abstract: OBJECTIVE
  Acute stroke in the setting of acute type A aortic dissection is not rare and may contraindicate immediate surgery. Evaluating irreversible brain damage is critical in this setting and magnetic resonance imaging is a key determinant in the decision of selecting surgical over medical treatment for these patients.
  
  
  METHODS
  We report herein 2 cases assessed at a tertiary care center for acute stroke. The initial diagnosis workup revealed cerebral hemispheric severe hypoperfusion without any brain infarction. The absence of ischemic lesions prompted surgical repair, despite the severity of clinical symptoms. Both patients demonstrated complete neurological recovery and neuroimaging showed no persistent sequel.
  
  
  CONCLUSIONS
  Acute type A aortic dissection is an important differential diagnosis in the causative workup for stroke. Brain hypoperfusion alone should not be a contraindication for urgent surgical treatment, regardless of initial clinical neurological severity.
authors.affiliation: Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Amr
authors.affiliation: Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: gregoireboulouis@gmail.com.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Boulouis
authors.affiliation: Department of Neuroradiology, Université Lille Nord de France, Hôpital Roger Salengro, CHRU de Lille, Lille Cedex, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bricout
authors.affiliation: Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Modine
authors.affiliation: Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Fayad
authors.affiliation: Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neuroradiology, Université Lille Nord de France, Hôpital Roger Salengro, CHRU de Lille, Lille Cedex, France; Service de Neuroradiologie Interventionnelle, Hôpital Prive Clairval, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Aguettaz
authors.affiliation: Service de Chirurgie Cardiovasculaire, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, Lille, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Koussa
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D000072226:Computed Tomography Angiography; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016896:Treatment Outcome
keywords: Aortic dissection; MRI; ischemic stroke; perfusion–diffusion mismatch