[Stanford Type A Acute Aortic Dissection With Brachiocephalic Artery Malperfusion and Consciousness Disturbance at Onset:Report of a Case].

Abstract

A 77-year-old woman complained of sudden chest pain and consciousness disturbance (Japan Coma Scale 3). Consciousness disturbance was improved( Japan Coma Scale 1) without paralysis on arrival at our hospital. Right upper-extremity and carotid arterial pulsation was impalpable. Contrast-enhanced computed tomography (CT) revealed dissection of the ascending aorta, and Stanford type A acute aortic dissection was diagnosed. The aortic dissection was extended into the brachiocephalic artery, which was occluded by the expanded false lumen. Head magnetic resonance imaging (MRI) identified no acute cerebral infarction. Urgent ascending aortic replacement was successfully performed with resection of the entry and removal of thrombus within the false lumen of the proximal brachiocephalic artery. The patient's postoperative course was uneventful without any neurological deficits. In acute aortic dissection with brachiocephalic artery malperfusion and neurologic symptoms, preoperative head MRI to confirm the presence or absence of acute cerebral infarction and operative resection of the entry would be useful.