CEREBRAL INFARCTION DUE TO PAINLESS THORACIC AORTIC AND COMMON CAROTID-ARTERY DISSECTIONS

Background. Aortic arch dissection is usually lethal unless emergency surgery is performed. The dissection rarely may have a benign outcome or may occur without pain and be revealed by cerebral infarction. It i s then likely to be seen primarily by a neurologist. In such cases, th e value of new noninvasive diagnostic testing has not been reported. C ase Description: A 51-year-old man had a sudden left-sided hemiplegia due to hemorrhagic capsular and caudate infarcts on the right side. Ce rvical ultrasound examination with color How imaging showed a bilatera l common carotid artery dissection extending up to the bifurcation. Tr ansesophageal echocardiography showed an aortic arch dissection, invol ving the inominate and left common carotid artery origins, which was c onfirmed by magnetic resonance imaging and aortography. The patient sp ontaneously fully recovered and is still alive 24 months after the str oke onset. Conclusions. This case emphasizes the usefulness of new non invasive techniques such as transesophageal echocardiography and color -coded Doppler echocardiography in the diagnosis and follow-up of pain less dissection of aortic and common carotid arteries. This cause of s troke may be underestimated.