title: Crucial role of carotid ultrasound for the rapid diagnosis of hyperacute aortic dissection complicated by cerebral infarction: A case report and literature review.
abstract: Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset. Systemic intravenous thrombolysis in the case of an acute brain infarction due to aortic dissection may lead to fatal outcomes. In this neurological emergency it is important to rule out underlying aortic dissection by choosing appropriately quick and accurate diagnostic tool. We aimed to present a prospective follow-up case, where carotid ultrasound examination was the primary key method that led to a correct diagnosis in hyperacute (<24h) Stanford type A aortic dissection presenting as an acute ischemic stroke, and thereafter with a repeated contrast-enhanced computed tomography and transthoracic echocardiography, helped to monitor topography of intravascular processes and hemodynamic properties during the clinical course of a disease, which influenced treatment decisions. Thus, we reviewed the literature mainly focusing on the various neurological aspects associated with aortic dissection.
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Eglė
authors.initials: E
authors.lastname: Sukockienė
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. Electronic address: kristina.lauckaite@lsmuni.lt.
authors.forename: Kristina
authors.initials: K
authors.lastname: Laučkaitė
authors.affiliation: Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Antanas
authors.initials: A
authors.lastname: Jankauskas
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Dalia
authors.initials: D
authors.lastname: Mickevičienė
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Giedrė
authors.initials: G
authors.lastname: Jurkevičienė
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Antanas
authors.initials: A
authors.lastname: Vaitkus
authors.affiliation: Institute of Physiology and Pharmacology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Edgaras
authors.initials: E
authors.lastname: Stankevičius
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Kęstutis
authors.initials: K
authors.lastname: Petrikonis
authors.affiliation: Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Daiva
authors.initials: D
authors.lastname: Rastenytė
mesh_terms: D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D018450:Disease Progression; D004452:Echocardiography; D006429:Hemiplegia / Q000175:diagnosis / Q000209:etiology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D021621:Imaging, Three-Dimensional; D008297:Male; D061185:Mechanical Thrombolysis; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler
keywords: Aortic dissection; Aortic imaging; Carotid ultrasound; Cerebral infarction; Neurological complications