Journal of Emergencies, Trauma, and Shock
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Year : 2021  |  Volume : 14  |  Issue : 3  |  Page : 191-192
Concurrence of intracranial hemorrhaging and stanford type a acute aortic dissection


Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo, Japan

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Date of Submission29-Mar-2021
Date of Acceptance10-May-2021
Date of Web Publication30-Sep-2021
 

How to cite this article:
Ohsaka H, Jitsuiki K, Takahashi D, Yanagawa Y. Concurrence of intracranial hemorrhaging and stanford type a acute aortic dissection. J Emerg Trauma Shock 2021;14:191-2

How to cite this URL:
Ohsaka H, Jitsuiki K, Takahashi D, Yanagawa Y. Concurrence of intracranial hemorrhaging and stanford type a acute aortic dissection. J Emerg Trauma Shock [serial online] 2021 [cited 2021 Dec 1];14:191-2. Available from: https://www.onlinejets.org/text.asp?2021/14/3/191/327091




Sir,

Ischemic stroke is occasionally complicated with acute aortic dissection. However, hemorrhagic stroke with acute aortic dissection was extremely rare.[1],[2],[3] We herein report a fatal case of the concurrence of intracranial hemorrhaging and Stanford type A acute aortic dissection with cardiac tamponade, confirmed by computed tomography (CT).

A 79-year-old woman fell down at work. Her personal and family history was unremarkable. Initially, she was able to speak with those around her. However, when emergency medical technicians (EMTs) checked her, she slipped into a deep coma approximately 30 min after her collapse. Her initial vital signs were as follows: Glasgow coma scale, E1V1M1; blood pressure, 214/100 mmHg; heart rate, 52 beats/min; respiratory rate, 10 breaths/min; SpO2, 99% under room air; temperature, 36.4°C. As she was snoring, the EMTs manually secured her airway and assisted in respiration using a bag valve mask. After 6 min, she entered cardiac arrest with 110 heart beats/min, so the EMTs began chest compression. Two minutes later, the staff of a physician-staffed helicopter met her and performed tracheal intubation and mechanical ventilation, secured a venous route, and delivered infusion of adrenaline every 4 min. The patient was transported via helicopter and underwent electrical shock because she developed ventricular fibrillation in the air. When she arrived at our hospital, she remained in cardiac arrest. Her initial rhythm was asystole. Ultrasound showed echo-free space around her heart, so she underwent emergency thoracotomy and pericardiotomy, resulting in the removal of a 300-g clot. However, she did not obtain spontaneous circulation. Autopsy imaging disclosed intraventricular and subarachnoid hemorrhaging in her head as well as Stanford A type aortic dissection [Figure 1]. Permission to perform a standard autopsy was not obtained from her family.
Figure 1: Computed tomography findings after resuscitation. Head computed tomography (left) showing intraventricular hemorrhaging and subarachnoid hemorrhaging, and thoracic computed tomography (right) showing Stanford A type aortic dissection (arrowhead)

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This is an extremely rare case of the concurrence of intracranial hemorrhaging and Stanford type A acute aortic dissection with cardiac tamponade. The bleeding source of intracranial hemorrhaging might have been a ruptured cerebral aneurysm or dissection of a cerebral artery in the posterior circulation, as head CT showed predominant hemorrhaging in the fourth ventricle. The mechanism underlying the concurrence might involve antecedent intracranial hemorrhaging inducing hypertension, which was confirmed in the present case, resulting in the occurrence of acute aortic dissection in a short time. Because the rupture of the aorta invariably causes a marked fall in blood pressure, the occurrence of cerebral hemorrhaging following aortic dissection with hemopericardium is highly unlikely.[3],[4] Thus, we presume that the aortic rupture occurred after the intracranial hemorrhaging. In addition, genetic factors contributing to a degenerative vasculature may have caused the concurrence.[2] As vascular diseases are systemic diseases, physicians should be alert for their concurrence when treating a patient with a vascular accident.

Acknowledgment

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from The Promotion and Mutual Aid Corporation for Private Schools of Japan.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent form. In the form, the patient has given her consent for her image and other clinical information to be reported in the journal. The patient understand that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Research quality and ethics statement

The authors followed applicable EQUATOR Network (http:// www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sonoo T, Wada T, Inokuchi R, Nakamura K, Nakajima S, Yahagi N. Putamen hemorrhaging occurred simultaneously with Stanford type A acute aortic dissection: A case report. Am J Emerg Med 2013;31:995.e3-4.  Back to cited text no. 1
    
2.
Inamasu J, Suzuki T, Wakako A, Sadato A, Hirose Y. Concurrence of aneurysmal subarachnoid hemorrhage and Stanford type A acute aortic dissection. J Stroke Cerebrovasc Dis 2016;25:e86-8.  Back to cited text no. 2
    
3.
Masui M, Wakasugi C. Hemopericardium following cerebral hemorrhage. Report of an autopsy case. Am J Forensic Med Pathol 1991;12:252-4.  Back to cited text no. 3
    
4.
Tanoue S, Yanagawa Y. Ischemic stroke with left hemiparesis or shock should be evaluated by computed tomography for aortic dissection. Am J Emerg Med 2012;30:836.e3-4.  Back to cited text no. 4
    

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Correspondence Address:
Youichi Yanagawa
Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Tokyo
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_50_21

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