Authors (including presenting author) :
Raymond Wai-man LEUNG (1), Karin Yuk-lan CHOW (1), Kelvin Lap-kiu TSOI (2)
Affiliation :
(1) NTWC Stroke Nursing Team, (2) Division of Neurology, Department of Medicine & Geriatrics, Tuen Mun Hospital
Keyword 2: :
Aortic Dissection
Introduction :
Aortic Dissection (AD) is a life-threatening emergency that can mimic acute ischemic stroke (AIS) by compromising cerebral circulation. This clinical "masquerade" poses a significant dilemma: while thrombolysis is the standard for AIS, it is a fatal contraindication for AD. In the hyperacute stroke setting, clinicians must balance the "time is brain" mandate with the need to exclude AD to avoid lethal consequence. Identifying high-risk clinical features is essential to prevent catastrophic outcomes. We reviewed recent AD cases presented in hyperacute stroke screening in the New Territories West Cluster (NTWC) to delineate the red flags of stroke-like AD.
Objectives :
To identify high-risk clinical features and demographic profiles of AD among patients presenting for hyperacute stroke screening.
Methodology :
A retrospective medical record review was conducted on consecutive patients undergoing hyperacute stroke screening within the NTWC stroke team’s catchment between November 2024 and November 2025. Demographic data, clinical presentations, and radiological findings were analyzed.
Result & Outcome :
Out of 2,688 hyperacute stroke screenings, 9 patients (0.3%) were diagnosed with AD. Patients with AD were significantly younger than the general stroke population (56.7±15.3 vs. 69.9±14.2 years; p=0.03). Most AD patients were male (77.8%) and 88.9% had Stanford Type A dissection. Key clinical "red flags" identified included: • Chest Discomfort: Present in 88.9% of AD cases. • Bilateral Arm Blood Pressure (BP) Difference: Found in 100% of AD cases (mean difference: 34.7±22.3 mmHg), a finding rare in typical AIS. • Radiological Markers: Widened mediastinum (>8cm) was present in all cases on chest X-ray (mean width: 97.5±9.1 mm). Mortality was high, with 44.4% of patients passing away during the index admission despite 22.2% receiving corrective surgery. The 0.3% of stroke mimics that are actually Aortic Dissections represent a 100% preventable mortality if bilateral blood pressure and CXR are screened diligently during hyperacute stroke window. Younger age, chest pain, bilateral arm BP discrepancy, and widened mediastinum are high-risk indicators for AD in stroke-like presentations. We recommend that stroke neurologists and nurses integrate BP discrepancy checks and CXR screening into hyperacute protocols for "atypical" stroke patients. Timely identification allows for life-saving CT-Aortography and prevents inappropriate thrombolysis.
