Cerebral subcortical hemorrhage rapidly followed by fatal Stanford Type A aortic dissection

Abstract

  Stanford Type A acute aortic dissection is a devastating condition that can complicate with stroke and commonly needs immediate surgical repair. A 51‒year‒old hypertensive man was transferred to our emergency room with hemiparesis and speech disturbance. At presentation, the patient’s blood pressure was 161/102 mmHg and he showed restless confusion, in addition to motor weakness in the left upper and lower extremities, and dysarthria. His blood examination showed an elevated level of serum D‒dimer, and a chest X‒ray found mild cardiomegaly with a cardiothoracic ratio (CTR) of 0.53. Cranial computed tomography (CT) scans revealed a subcortical hematoma in the right frontal lobe, 38 mm x 34 mm in maximal diameter with less mass effect. The patient complained of chest pain immediately after the CT scans and suffered abrupt cardiopulmonary arrest a few minutes later. Prompt cardiopulmonary resuscitation did not achieve spontaneous circulation. A chest X‒ray taken after endotracheal intubation showed a considerable increase in the CTR to 0.61. Autopsy imaging revealed disruptions of the wall of the ascending aorta and the collection of pericardial effusion. Based on these results, we assumed that the patient died of cardiac tamponade caused by a Stanford Type A acute aortic dissection that developed rapidly following subcortical hemorrhage. Acute aortic dissection should be assumed to be a possible complication of intracerebral hemorrhage.