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Catastrophic Type A Aortic Dissection Temporally Associated With Recreational Ketamine Use

C.d. Bissell, Kenneth S. Rankin

Cureus November 20, 2025 DOI: 10.7759/cureus.97346 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Case report Peer reviewed
Sample size 1
Population 57-year-old woman with no known medical history
Intervention intranasal ketamine
Topics Ketamine Esketamine
Keywords Aortic dissection Intubation Dissection medical Aorta Anesthetic Airway Anesthesia Surgery Angiography Altered mental status Aortic aneurysm Cardiology
Citations 1
Key findings Intranasal ketamine use can precipitate Type A aortic dissection via sympathomimetic effects, leading to fatal outcomes.

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.

Comparable studies

Other case reports and case series on ketamine, most cited first.

Study Year Design Participants
The destruction of the lower urinary tract by ketamine abuse: a new syndrome? Young recreational abusers of street-ketamine in Hong Kong referred to urology units 2008 Retrospective case series n = 59
Electroconvulsive Therapy, Ketamine, and Esketamine in a Patient with Major Depressive Disorder and Multiple Comorbidities: A Case Report over 10-year Treatment from Adolescence to Adulthood. A patient with treatment-resistant depression and comorbid generalized anxiety... 2025 Case report n = 1
Treatment of compulsive behaviour in eating disorders with intermittent ketamine infusions Chronic and treatment-resistant eating disorder patients 1998 Case series n = 15
Oral Administration of the NMDA Receptor Antagonist S-Ketamine as Add-On Therapy of Depression: A Case Series Four depressed patients taking standard antidepressants 2009 Case series n = 4
A longitudinal case series of IM ketamine for patients with severe and enduring eating disorders and comorbid treatment‐resistant depression Patients with enduring eating disorders and treatment-resistant depression 2021 Case series n = 4

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