以腦中風表現之主動脈合併雙側頸動脈剝離病例報告

Aortic and Bilateral Carotid Arterial Dissection Presented with Acute Ischemic Stroke: A Case Report

意識不清、失語症及肢體無力等神經學症狀是腦 中風常見的臨床表現。本案為54歲女性，以腦中風的神經症狀合併暫時意識喪失、低血壓及冒 冷汗等症狀，初步診斷為急性梗塞性腦中風。經頸部超音波檢查發現雙側頸動脈剝離，頸部及胸部電腦斷層確診為史丹福A型主動脈剝離合併雙 側頸動脈剝離，經外科緊急手術治療後仍不幸死 亡。典型的主動脈剝離以嚴重如撕裂般的胸痛、 背痛和高血壓為主要臨床表徵。當個案出現非典 型症狀時，可藉由非侵入性檢查如四肢肢體脈搏和血壓的測量、頸部及心臟超音波檢查，配合抽 血檢驗如D-D雙合試驗，作初步的鑑別診斷， 當高度懷疑有動脈剝離時應立即安排電腦斷層檢查，以降低延遲診斷或誤診的機率，達到及早治療的目的。

 

Neurological symptoms, such as unconsciousness, aphasia and limbs weakness, are common clinical manifestations of stroke. But atypical presentations due to rare etiology may delay correct diagnosis. We present a 54-year-old female stroke patient with transient consciousness disturbance, hypotension and profound cold sweating. The initial diagnosis was acute infarction stroke. Carotid duplex ultrasound showed bilateral common carotid artery, carotid bifurcation, internal carotid artery and external carotid artery dissections. Stanford type A aortic dissection was diagnosed after CT angiography and thoracic computed tomography. Unfortunately, she passed away soon after emergent aortic vascular surgery. Typical symptoms of aortic dissection are characterized by severe tearing chest and back pain and high blood pressure. When patients present with atypical symptoms, non-invasive tests such as bilateral limb pulse, blood pressure measurements, carotid duplex ultrasound and echocardiography could provide important clinical clues. Additionally, blood tests, such as D-Dimer, may also help initial differential diagnosis. Computerized tomography should be performed immediately when aortic dissection is suspected clinically to reduce the probability of delayed diagnosis or misdiagnosis and irreversible morbidity or death.