PMC10025093_01
Pre-operative computed tomography showimg extended type II dissecting thoraco-abdominal aortic aneurysm.
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A 61 year old man, who had developed an acute type B aortic dissection five years previously, required extent II thoraco-abdominal aortic replacement for chronic type B aortic dissection with TAAA degeneration (maximum diameter 55 mm) (Fig. 1).
Post-operative acute phase brain computed tomography shows hypo-attenuation in both posterior lobes (A). These findings are consistent with the patient's bilateral visual disturbance. Microbleeds are confirmed as the high intensity spots (red arrow). Brain magnetic resonance imaging, performed after extubation, demonstrate an apparent low diffusion coefficient (B) and, high diffusion weighted imaging (C) areas, implying infarctions. Further, extended high intensity of the posterior lobes was noted on fluid attenuated inversion recovery images (D). T2 star weighted image suggests microbleeds (E) and magnetic resonance angiography shows constricted posterior circulation vessels (F).
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Brain computed tomography (CT) showed a low density area with microbleeds in the posterior lobes (Fig. 2A). After extubation, on POD 6, magnetic resonance imaging (MRI) showed bilateral oedematous posterior lobes with several microbleeds and infarctions (Fig. 2B-E). Multiple interrupted stenoses of the vertebral and basilar arteries were detected (Fig. 2F).
Fluid attenuated inversion recovery imaging showing improvement of cerebral oedema (A1, B1, C1, D1); however, chronic ischaemia remains. Magnetic resonance angiography (MRA) shows interrupted constrictions of basilar and vertebral arteries. Serial MRA shows improvement of the constrictions over time (A2, B2, C2, D2). (A) Post-operative day (POD) 7; (B) POD 11; (C) POD 21; (D) POD 32.
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MRI (Fig. 3) showed improvements in cerebral oedema and vasoconstriction; however, the area of infarction remained. Moreover, post-operative CT revealed occlusion of the bypass to the intercostal arteries.