Painless Aortic Dissection with Unusual Extension into Intracranial Internal Carotid Arteries

Iyadurai, Stanley; Sharma, Vijay K.; Tsivgoulis, Georgios; Lao, Annabelle Y.; Alexandrov, Andrei V.

doi:10.1159/000106517

Cited by 19 publications

(14 citation statements)

References 5 publications

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“…The dissected intima was not causing a permanent stenosis, but instead it was flapping in synchrony with the vessel pulse. Although TCD examination may also suggest the presence of extracranial dissection, [10][11][12] in our case TCD did not reveal significant velocity changes. In conclusion, although the visualization of the flapping dissected intima could be the only sign of a CAD.…”

Section: 3contrasting

confidence: 65%

Flapping of the dissected intima in a case of traumatic carotid artery dissection in a jackhammer worker

Vadikolias

Heliopoulos

Serdari

et al. 2009

J of Clinical Ultrasound

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We present the sonographic finding of flapping of the dissected intima inside the carotid artery in a 48-year-old man who suffered an acute stroke after vigorous use of a jackhammer. The dissected intima was seen to flap inside the lumen regularly and in synchrony with the vessel's pulse. There was no distal segmental stenosis. The extracranial blood flow velocities were within normal limits and transcranial Doppler examination did not reveal any velocity alteration.

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Section: 3contrasting

confidence: 65%

Flapping of the dissected intima in a case of traumatic carotid artery dissection in a jackhammer worker

Vadikolias

Heliopoulos

Serdari

et al. 2009

J of Clinical Ultrasound

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“…A paucity of cases reported in the literature deal with this issue; the majority favor avoiding the use intravenous alteplase in the setting of aortic dissection. [415][416][417] When intravenous alteplase was administered in the setting of acute stroke, some patients developed symptoms such as flank pain, 414 chest and ear pain, 418 or a cold extremity with no palpable pulse. 419 Further imaging revealed aortic dissection in each case.…”

Section: Demaerschalk Et Al Intravenous Alteplase In Acute Ischemic Smentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

550

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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“…Especially in the context of neurological sequelae of aortic dissection numerous patients without notable pain were reported [5,14,15,16,17,18,19,20,21,22]. While Hagan et al [4] reported that most of their patients who presented with stroke also gave a history of pain, in our own study [5] only two thirds of patients with neurological symptoms at onset of dissection complained of pain, whereas most patients without neurological symptoms (94.4%) experienced initial pain.…”

Section: Atypical Presentation Of Aortic Dissectionsmentioning

confidence: 99%

“…Symptoms of acute ischemic stroke are the most common initial neurological finding [5, 13, 14, 17, 18, 27, 30]. Preoperative strokes tend to be more frequently hemispheric compared with vertebral-basilar location and predominantly right-sided [5, 27, 32].…”

Section: Symptoms Of Brain Involvementmentioning

confidence: 99%

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

2008

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Typically, aortic dissection has to be considered in patients with acute thoracic or abdominal pain and accompanying cardiovascular symptoms. Due to these clinical symptoms, neurologists have not been involved in the routine emergency management of aortic dissection. However, transient or permanent neurological symptoms at onset of aortic dissection are not only frequent (17–40% of the patients), but often dramatic and may mask the underlying condition. Especially in pain-free dissection (which occurs in 5–15%) with predominant neurological symptoms diagnosis of aortic dissection can be difficult and delayed. Affecting the outflow of supra-aortal, spinal as well as extremity arteries leads to a variety of neurological symptoms including disturbances of central or peripheral nervous system. Thrombolysis as an emergency stroke therapy without considering aortic dissection may be life-threatening for these patients. Routine chest X-ray and being alert to physical examination findings such as hypotension, asymmetrical pulses or cardiac murmur may reduce risk of delayed diagnosis or misdiagnosis. Neurological symptoms at onset or in the postoperative course of aortic dissection are not necessarily associated with increased mortality.

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Painless Aortic Dissection with Unusual Extension into Intracranial Internal Carotid Arteries

Cited by 19 publications

References 5 publications

Flapping of the dissected intima in a case of traumatic carotid artery dissection in a jackhammer worker

Flapping of the dissected intima in a case of traumatic carotid artery dissection in a jackhammer worker

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Neurological Symptoms in Aortic Dissection: A Challenge for Neurologists

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