Aortic dissection and carotid arteries dissection complicated by ischaemic stroke in a patient with cystic medial necrosis

• Published in: Neurologia i neurochirurgia polska Vol. 43; no. 6; p. 584
• Main Authors: Jachińska, Katarzyna, Lipczyńska-Łojkowska, Wanda, Kuran, Włodzimierz, Rozenfeld, Anna, Grochowska, Elzbieta, Szpak, Grazyna M, Lenart, Janusz
• Format: Journal Article
• Language: Polish
• Published: Poland 01.11.2009
• Subjects: Aneurysm, Dissecting - complications; Aneurysm, Dissecting - pathology; Aortic Aneurysm - complications; Aortic Aneurysm - pathology; Aortic Aneurysm, Thoracic - complications; Aortic Aneurysm, Thoracic - pathology; Autopsy; Carotid Artery Diseases - complications; Carotid Artery Diseases - pathology; Carotid Artery, Internal, Dissection - complications; Carotid Artery, Internal, Dissection - pathology; Cerebral Infarction - complications; Cerebral Infarction - pathology; Fatal Outcome; Humans; Male; Middle Aged; Necrosis
• ISSN: 0028-3843

We present a case of a 62-year-old man who was admitted in grave condition to the Institute of Psychiatry and Neurology because of ischaemic stroke. Neurological examination re- vealed left-sided pyramidal hemiparesis. Computed tomography (CT) showed the ischaemic focus in the right cerebral hemisphere. Clinical examination and ultrasound examination revealed dissection of the aortic arch and extracranial arteries. Aortic dissection was confirmed in echocardiography and chest CT. The patient remained comatose and died after 7 days. Post-mortem examination identified dissection of the aortic arch, brachiocephalic truncus, common carotid arteries, internal carotid arteries and dissection extending along the whole aorta into both iliac arteries. This examination also showed a massive haemopericardium and a scar in the heart muscle after myocardial infarction. Microscopic examination identified cystic medial necrosis. This type of dissection is very rarely described.