engleski

CATHEDRAL LIKE HEMODYNAMIC SPECTRA AS THE ONLY SIGN OF AORTIC ARCH DISSECTION

CATHEDRAL LIKE HEMODYNAMIC SPECTRA AS THE ONLY SIGN OF AORTIC ARCH DISSECTION In the absence of sudden chest pain, aortic arch dissection remains unrecognized. We present a case of a patient with aortic arch dissection presenting as encephalopathy following comatose state after sudden collapse. The 55 years comatose patient after sudden collapse with apnoic crisis and severe hypotension was admitted to Neurologic Intensive Care Unit. Glasgow Coma Scale was 6 (1+4 withdraws to pain stimuli on the left+1). Two days before admittance he had chest pain. The history on hypertension was negative. 45 years ago rheumatic fever. Smoker. Twenty minutes after therapy, blood pressure was stabilized without asymmetry, patient revealed conscious, without lateralization, orientated, but strongly agitated and with strong psychomotor restlessness despite sedation therapy. No cardiac murmurs could be registered. Blood tests were normal, electrocardiography, repeated chest radiography ; brain computerized tomography and electroencephalography were normal. Toxicologic analysis was negative. Cerebrospinal analysis was normal. Antiepileptic and sedative therapy was started, but without effect. Transient elevation of CPK up to 19700 due to psychomotor NEMIR was observed. The sixth day of hospitalization patient becomes dyspnoic accompanied by sweating and restlessness. The seventh day blood pressure could not be measured on the left arm. Carotid color Doppler revealed normal morphologic finding on the carotid arteries, but the hemodynamic spectra were changed with cathedral like appearance, and negative deflection during the diastole. Subclavian steal syndrome in the left vertebral artery was present. Transcranial Doppler revealed the same hemodynamic spectra in the vessels of the Willis circle. Echocardiography showed the dilatation of the supravalvular aorta with intimal flapping, bicuspid aortic valve with massive aortic regurgitation and pericardial effusion. Chest CT confirmed aortic arch dissection, and patient was transferred to Department of cardiology. After cardiac therapy, patient was compensated. Control Doppler revealed the same findings. After one month, neurologic and psychiatric examination revealed normal findings. Aortic arch dissection remains usually underdiagnosed. Therefore carotid and transcranial Doppler should be applied in patients with unusual clinical picture, because spectra may indicate proximal disease.

dissection; aortic arch; haemodynamics; TCD

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