Description

A 57-year-old hypertensive man presented to the emergency department with right hemiparesis (blood pressure 145/90 mm Hg). An emergent head CT was performed confirming an ischaemic stroke (figure 1) and the patient underwent fibrinolysis. Within 12 h he developed shortness of breath with hypoxia and inspiratory crackles on auscultation. Transthoracic echocardiogram showed an ascending aortic aneurysm with an aortic flap and severe aortic regurgitation (figure 2A, B). Stanford type A aortic dissection was confirmed by CT angiography (figure 3). The tear was localised in the proximal ascending aorta and the dissection propagated along the aortic arch to the right carotid (figure 3A) and descending thoracoabdominal aorta (figure 3 …