以脑梗死为首发症状的主动脉、左侧颈总动脉夹层1例

A Case of the Aortic and Left Common Carotid Artery Dissection in the Adults Who Starts with the Symptoms of Acute Cerebral Infarction

摘要: 目的：回顾性分析1例以脑梗死为首发症状的无痛性主动脉夹层A型合并左侧颈总动脉夹层患者的临床资料，并查阅相关文献进行总结性分析，提高临床医生对以神经系统症状为首发表现的主动脉夹层的认识。方法：回顾性分析吉林大学第二医院收治的1例以脑梗死为首发症状的无痛性主动脉夹层A型合并左侧颈总动脉夹层患者的临床资料，并查阅复习相关文献，分析主动脉夹层的发病机制、病因、临床表现、诊断及治疗，并总结出快速识别主动脉夹层的方法。结果：主动脉夹层的典型特征为突发刀割或撕裂样剧痛，但因夹层累及不同血管而临床表现多样，当以疑似缺血性脑卒中症状或其他神经系统症状为首发表现时，应该详细询问病史，密切观察意识障碍变化及监测双上肢血压。同时完善头部、胸部CT、颈动脉彩超及D-二聚体等检查，若仍高度怀疑主动脉夹层，应行主动脉及头颈部CTA检查，避免不必要的溶栓，对主动脉夹层做到早期诊断及治疗。结论：主动脉夹层病情进展迅速，当患者出现以疑似缺血性脑卒中症状或是各种神经系统症状的组合为首发症状时，详细的问诊、仔细的体格检查及必要时影像学检查是快速识别主动脉夹层的关键，为下一步治疗赢得时间。

Abstract: Objective: The clinical data of a case of the Aortic and Left Common carotid artery Dissection in the adults who starts with the Symptoms of Acute Cerebral Infarction were retrospectively analyzed and reviewed the relevant literature in order to improve clinical doctors’ understanding of aortic dissection when neurological symptoms as the starting performance. Methods: The clinical data of a case of the Aortic and Left Common carotid artery Dissection in the adults who starts with the Symptoms of Acute Cerebral Infarction in the Second Affiliated Hospital of Jilin University were retrospectively analyzed, we reviewed the related literature in order to analyze the pathogenesis, etiology, clinical manifestation, diagnosis and therapy of aortic dissection, and summarized the method of fast identification of aortic dissection. Results: Typical features of aortic dissection are cutting or tearing pain, but it has diverse clinical manifestations because aortic dissection affects different blood vessels. When aortic dissection starts with the suspected ischemic stroke symptoms or other neurological symptoms, we should ask for history of the disease carefully, observe closely the change of consciousness and monitor the double arm blood pressure. On the meanwhile, we should complete the head CT, chest CT, arotid artery ultrasound and D-dimer check, if aortic dissection is suspected highly, aorta and head, neck CTA is essential. We should avoid unnecessary thrombolysis and complete early diagnosis and treatment of aortic dissection. Conclusion: Aortic dissection progress rapidly and have diverse clinical manifestations, when patients start with suspected ischemic stroke symptoms or the combination of various neurological symptoms, detailed interrogation and careful physical examination and necessary imaging examination is the key to identify rapidly aortic dissection, it will win time for the next treatment.