Abstract
Background/Objectives Acute aortic syndromes (AAS) may have stroke at presentation. The performance of the aortic dissection detection risk score (ADD-RS) in this cohort is uncertain, especially when confounded by dysphasia or language barriers. This study aims to describe the presenting features of patients with AAS and stroke and determine the performance of the ADD-RS in this cohort.
Methods An 18-month retrospective cohort study of all CT-Aortograms from two tertiary hospitals was performed. ADD-RS was calculated for each patient identified to have AAS.
Results Of the 26 patients identified to have AAS on CT-angiogram, 3 patients had concurrent stroke and AAS. Two had ischaemic strokes secondary to AAS and the third is thought to be due to intracerebral haemorrhage as a result of hypertension accompanying AAS. Two of the three patients suffered in-patient mortality. All AAS patients with stroke presented with some degree of focal neurological deficit. Features suggestive of AAS that were present included abrupt chest pain, severe chest pain, pulse deficits, hypotension, and systolic blood pressure differential. These stroke cases had a median ADD-RS of 2 (range 1 to 2). An ADD-RS threshold of ≥2 had a false negative rate of 33%.
Conclusion These findings demonstrate that an ADD-RS threshold of 2 may miss cases of AAS associated with stroke. The possibility of AAS should be considered by clinicians even when a classical history of chest or back pain is absent, and aortic arch imaging should be reviewed closely on code stroke sequences.
