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題 名 | Acute Aortic Dissection Presenting as Stroke--A Case Report=急性主動脈剝離以腦中風表現--一病例報告 |
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作 者 | 蘇正煌; 洪大川; 周友三; 蔡正河; 侯守賢; | 書刊名 | Acta Cardiologica Sinica |
卷 期 | 13:3 民86.07-09 |
頁 次 | 頁163-168 |
分類號 | 416.263 |
關鍵詞 | 急性主動脈剝離; 腦中風; 經胸心臟超音波; Acute aortic dissection; Stroke; Transthoracic echocardiography; |
語 文 | 英文(English) |
中文摘要 | 背景:雖然不常見,腦中風為急性主動脈剝離之一重要臨床表現。本篇報告描述一位女性患者,以腦中風表現入院;而經胸心臟超音波檢查意外發現急性主動脈剝離。 方法與結果:一名74歲婦女,無高血壓病史,因暈厥,失語及左側肢體乏力入神經科病房。腦病電腦斷層檢查顯示右側基底核梗塞。理學檢查發現心舒期雜音及古頸動脈雜音,施以經胸心臟超音波檢查,於降主動脈偵測得有血管內膜皮瓣漂浮。彩色杜普勒超音波發現有血流灌注於降主動脈偽腔中。胸部電腦斷層檢查確定診斷為急性A型主動脈剝離並伴有右側無名動脈血栓形成,而造成患者腦中風臨床表現。不幸地,患者意識狀態快速惡化,我們施以主動脈緊急手術希望避免腦梗塞進一步擴大,但患者於手術後5小時內死亡。 結論:臨床上我們須留意下列幾項: 第一點、腦中風患者,尤其當伴隨有頸動脈雜音,必須排除急性主動脈剝離可能性; 第二點、經胸心臟超音波,是一項不可缺少的臨床檢查工具; 第三點、急性A型主動脈剝離導致昏迷的腦中風患者,手術治療時機取決於中風或主動脈剝離何者最危及生命。 |
英文摘要 | Background. Although not common, stroke is an important element in the clinical presentation of a patient with acute aortic dissection. This report describes a case of stroke with rapid consciousness deterioration to coma. In addition, acute aortic dissection was detected, incidentally by transthoracic echocardiographic (TTE) examination. Methods and Results. A 74-year-old female was admitted because of syncope and weakness of the left extremities. Computed tomography (CT) of the brain revealed a right basal ganglia infarction. Transthoracic echocardiography (TTE) was performed owing to a cardiac murmur and a right carotid bruit. Unexpectedly a floating intimal flap was seen at the dilated descending aorta, with blood flow in the false lumen. CT of the chest confirmed the diagnosis of acute type A aortic dissection with involvement of the right innominate artery compatible with this patient's clinical symptoms of stroke. Unfortunately, the patient's consciousness deteriorated rapidly, and thus an emergency operation was performed in an attempt to prevent further brain infarction. However, the patient expired five hours after the operation. Conclusion. The following should be kept in mind: 1.the possibility of acute type A aortic dissection must be excluded in a patient presenting with stroke, especially when carotid bruit is detected; 2.TTE is an indispensable tool for bedside evaluation; 3.surgical treatment for acute type A aortic dissection in a nearly comatous patient due to stroke may be useful but depends on which condition is life-threatening, stroke or aortic dissection. |
本系統中英文摘要資訊取自各篇刊載內容。