An Unusual Vascular Catastrophe: Atheromatous Aortic Dissection With Renal Artery Thrombosis and Cortical Laminar Necrosis Post Cerebral Ischemia

Spontaneous atheromatous aortic dissection is a rare but serious vascular complication caused by the rupture of an atherosclerotic plaque, leading to distal vessel occlusion and ischemic injury such as acute renal infarction. Cortical laminar necrosis (CLN) represents a permanent form of cerebral cortical damage following severe ischemia, characterized by selective neuronal necrosis and distinct radiological features, and is associated with poor neurological prognosis. We report the case of a 67-year-old woman with atrial fibrillation, heart failure, peripheral vascular disease, and a heavy smoking history of 40 pack-years, who presented with sudden expressive dysphasia and right-sided weakness. Initial brain computed tomography (CT) demonstrated a subacute left frontal infarction, and follow-up imaging confirmed cortical laminar necrosis. During admission, she developed abrupt anuria and stage 3 acute kidney injury without abdominal pain. CT angiography revealed the spontaneous atheromatous dissection of the abdominal aorta below the superior mesenteric artery, with the complete thrombosis of the right renal artery causing acute infarction, and a chronically atrophic left kidney from long-standing ischemia. In view of multiorgan involvement and poor prognosis, a multidisciplinary decision was made for palliative care. This case illustrates the occurrence of two uncommon but severe vascular complications in a patient with significant cardiovascular risk factors: spontaneous atheromatous dissection leading to renal artery thrombosis (RAT) and cortical laminar necrosis following ischemic stroke. Both conditions reflect the systemic burden of advanced atherosclerosis and underscore the importance of early recognition, prompt imaging, and a multidisciplinary approach to guide management in high-risk patients.