Catastrophic Type A Aortic Dissection Temporally Associated With Recreational Ketamine Use
Cureus – November 20, 2025
Source: OpenAlex
Summary
A 57-year-old woman experienced a catastrophic aortic dissection after using intranasal ketamine, leading to acute altered mental status. Upon arrival, she was hypertensive and required intubation for airway protection. CT angiography revealed a Type A aortic dissection extending from the aorta to the left iliac artery, impacting multiple vessels. Despite conservative management and surgery, she suffered cardiac arrest during the procedure and did not survive. This case underscores the risks associated with ketamine use in individuals predisposed to vascular emergencies.
Abstract
Aortic dissection is a life-threatening vascular emergency, typically associated with hypertension, connective tissue disease, or stimulant drug use. Ketamine, a dissociative anesthetic with sympathomimetic properties, is rarely implicated in major cardiovascular events. This case report describes a 57-year-old woman with no known medical history who presented with acute altered mental status after reported intranasal ketamine use and subsequent back pain. On arrival, she was obtunded and hypertensive, requiring intubation for airway protection. CT angiography revealed a Type A aortic dissection extending from the root to the left iliac artery with involvement of the carotid, mesenteric, and renal vessels. Despite initial conservative management and later surgical intervention, the patient suffered intraoperative cardiac arrest and was pronounced deceased. This case highlights the potential for ketamine-induced sympathomimetic effects to precipitate vascular catastrophe in susceptible individuals.