Aortic dissection masquerading as a code stroke: A single-centre cohort study

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Aortic dissection masquerading as a code stroke: A single-centre cohort study. / Guglielmi, Valeria; Groeneveld, Nina-Suzanne; Posthuma, Laura et al.

In: European Stroke Journal, Vol. 5, No. 1, 01.03.2020, p. 56-62.

Research output: Contribution to journal › Article › Academic › peer-review

BibTeX

@article{7dbba62dcd234f928990d53b10626a62,

title = "Aortic dissection masquerading as a code stroke: A single-centre cohort study",

abstract = "Introduction: Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre. Patients and methods: We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke ({\textquoteleft}code stroke{\textquoteright}). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries. Results: Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0–2). Discussion and Conclusion: In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.",

keywords = "Aortic dissection, ischaemic stroke, stroke, transient ischaemic attack",

author = "Valeria Guglielmi and Nina-Suzanne Groeneveld and Laura Posthuma and Groot, {Adrien E.} and Majoie, {Charles B. LM} and Hanna Talacua and Abdullah Kaya and Boekholdt, {S. Matthijs} and Planken, {R. Nils} and Roos, {Yvo B. WE. M.} and Coutinho, {Jonathan M.}",

year = "2020",

month = mar,

day = "1",

doi = "10.1177/2396987319883713",

language = "English",

volume = "5",

pages = "56--62",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "SAGE Publications Inc.",

number = "1",

}

RIS

TY - JOUR

T1 - Aortic dissection masquerading as a code stroke: A single-centre cohort study

AU - Guglielmi, Valeria

AU - Groeneveld, Nina-Suzanne

AU - Posthuma, Laura

AU - Groot, Adrien E.

AU - Majoie, Charles B. LM

AU - Talacua, Hanna

AU - Kaya, Abdullah

AU - Boekholdt, S. Matthijs

AU - Planken, R. Nils

AU - Roos, Yvo B. WE. M.

AU - Coutinho, Jonathan M.

PY - 2020/3/1

Y1 - 2020/3/1

N2 - Introduction: Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre. Patients and methods: We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke (‘code stroke’). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries. Results: Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0–2). Discussion and Conclusion: In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.

AB - Introduction: Data on the incidence of acute aortic dissection in the code stroke population are scarce. We report estimated incidence, clinical manifestations, treatment and outcomes of patients with an acute aortic dissection in a code stroke cohort from a comprehensive stroke centre. Patients and methods: We used data from a single-centre prospective registry of consecutive adult patients who presented to the emergency department between 2015 and 2018 with neurological deficits suggestive of an acute stroke (‘code stroke’). All patients routinely underwent non-contrast computed tomography of the brain and computed tomography-angiography of the aortic arch, cervical and intracranial arteries. Results: Of 2874 code stroke patients, 1563 (54.4%) had acute ischaemia (ischaemic stroke or transient ischaemic attack). Fifteen patients (0.5% of code stroke patients and 0.8% of patients with acute ischaemia) had an acute aortic dissection (all Stanford classification type A). Discerning clinical manifestations were decreased consciousness in 11/15 (73%), pain in 8/15 (53%) and low systolic blood pressure (mean 106 mmHg, SD30). Acute aortic dissection was an incidental finding during computed tomography-angiography in 4/15 (27%). Two out of 15 patients (13%) received intravenous thrombolysis, 9/15 (60%) underwent aortic surgery and 10/15 (67%) died. Of those who survived, 3/5 (60%) had a good functional outcome (modified Rankin Scale 0–2). Discussion and Conclusion: In our comprehensive stroke centre, about 1/200 code stroke patients and 1/125 patients with acute ischaemia had an acute aortic dissection. Multicentre studies are necessary to acquire a more reliable estimate of the incidence of acute aortic dissection in the code stroke population. Given the ramifications of missing this diagnosis, imaging of the entire aortic arch is important in these patients.

KW - Aortic dissection

KW - ischaemic stroke

KW - stroke

KW - transient ischaemic attack

UR - http://www.scopus.com/inward/record.url?scp=85074424592&partnerID=8YFLogxK

U2 - 10.1177/2396987319883713

DO - 10.1177/2396987319883713

M3 - Article

C2 - 32232170

VL - 5

SP - 56

EP - 62

JO - European Stroke Journal

JF - European Stroke Journal

SN - 2396-9873

IS - 1

ER -

ID: 7340156

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