経頭蓋超音波ドプラが診断および経過観察に有用であった慢性期胸部大動脈解離に伴う脳梗塞の一例

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Acute type A aortic dissection still carries high morbidity and mortality. Sometimes aortic dissection triggers neurological symptoms mainly associated with stroke.We report the case of a 57-year-old man with a history of aortic valve and thoracic aorta replacement for type A aortic dissection. He suddenly experienced motor aphasia. Magnetic resonance imaging revealed a left middle cerebral artery (MCA) territory infarction on diffusion-weighted images. Computed tomography confirmed a chronic type A dissection with persistent blood flow into the false lumen at the thoracic aorta and left common carotid artery. In transcranial Doppler monitoring, microembolic signals were observed only at the left MCA. Therefore, the thrombus came from only the left carotid artery, not the aortic valve or aortic arch. Anti-coagulant therapy reduced the number of microembolic signals at the left MCA. After starting that treatment, no new neurological deficits were found and no new lesions were detected on magnetic resonance images.Transcranial Doppler ultrasonography monitoring is useful for evaluating the etiology of cerebral infarction and predicting clinical courses.