Catastrophic Type A Aortic Dissection Temporally Associated With Recreational Ketamine Use

A 57-year-old woman with no known medical history presented with acute altered mental status after intranasal ketamine use, followed by back pain. She was obtunded and hypertensive, requiring intubation. CT angiography revealed a Type A aortic dissection extending from the aortic root to the left iliac artery, involving the carotid, mesenteric, and renal vessels. Despite initial conservative management and later surgery, she suffered intraoperative cardiac arrest and died. The case highlights that ketamine's sympathomimetic effects can precipitate aortic dissection in susceptible individuals.

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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.