Acute Type A Aortic Dissection with Concomitant Intracerebral Haemorrhage: A Therapeutic Dilemma Regarding the Timing of Surgery

Acute type-A aortic dissection is a life-threatening emergency requiring prompt surgical intervention. However, the management of patients presenting with concomitant intracerebral haemorrhage remains challenging, as the risk of neurological deterioration during surgery must be balanced against the risk of fatal aortic rupture. We report the rare case of a 68-year-old patient diagnosed with acute intracerebral haemorrhage involving the parietal lobe and right frontal region in association with acute type-A aortic dissection. Due to the neurological condition, a delayed surgical strategy was chosen. Six weeks after the initial diagnosis, supracoronary hemiarch replacement of the ascending aorta was successfully performed without postoperative neurological complications. This case highlights the complexity of decision-making in patients with simultaneous acute aortic pathology and intracranial bleeding. This educational report emphasises that immediate surgical repair remains the standard of care. The delayed strategy described here was dictated by an absolute contraindication to anticoagulation and reflects an exceptional, individualised management approach rather than a general therapeutic recommendation.