Combined cardiac-neurosurgical treatment of acute aortic dissection, stroke, and coma

Tex Heart Inst J. 2008;35(2):200-2.

Abstract

Coma or stroke with secondary brain malperfusion is usually considered a strong contraindication for emergent surgical treatment of acute aortic dissection. Herein, we present the case of a 30-year-old woman who presented with sudden left hemiplegia and level-7 coma on the Glasgow Coma Scale. Transthoracic echocardiography showed type A aortic dissection. Although the patient was unable to communicate, her family approved an emergency Bentall operation. She regained consciousness but developed anisocoria and Glasgow Coma Scale level-4 coma 30 hours after the operation. Computed tomography showed massive cerebral infarction with hernia of the uncus gyri hippocampi. Emergency surgical cerebral decompression was performed. The patient survived; after 1 year, she had full mental acuity and minor left motor sequelae.

Keywords: Age factors; aneurysm, dissecting/complications/surgery; aortic aneurysm, thoracic/complications/mortality/surgery; brain ischemia/surgery; cardiovascular surgical procedures; cerebrovascular disorders/etiology/mortality/surgery; coma/complications; emergency treatment/contraindications; postoperative complications/prevention & control; risk management; stroke/complications; treatment outcome.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aortic Aneurysm / complications
  • Aortic Aneurysm / diagnosis
  • Aortic Aneurysm / surgery*
  • Aortic Dissection / complications
  • Aortic Dissection / diagnosis
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology
  • Brain Ischemia / surgery*
  • Coma / diagnosis
  • Coma / etiology
  • Coma / surgery*
  • Decompression, Surgical
  • Female
  • Humans
  • Stroke / diagnosis
  • Stroke / etiology
  • Stroke / surgery*