Kosin Med J.  2017 Jun;32(1):127-132. 10.7180/kmj.2017.32.1.127.

Aortic Dissection after Intravenous Thrombolysis in Acute Cerebral Infarction

• Do YR

• KMID: 2384842
• DOI: http://doi.org/10.7180/kmj.2017.32.1.127

Abstract

Use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute cerebral infarction secondary to aortic dissection is challenging because of a narrow time window and potential life-threatening complications. An 80-year-old woman with right middle cerebral artery infarction was treated with rt-PA. Although she had no history, symptoms, or sign of aortic dissection, carotid CT angiography revealed aortic arch dissection. Mediastinal widening, which did not show on initial chest X-ray, developed on follow-up chest X-ray. This observation indicates that physicians should monitor patient symptoms for signs of aortic dissection during thrombolysis and perform chest X-ray or carotid angiography immediately after thrombolysis even if the patient has no symptoms or signs of aortic dissection on onset of acute cerebral infarction.

Keyword

Cerebral infarction; Dissection; Thrombolytic therapy

MeSH Terms

Aged, 80 and over
Angiography
Aorta, Thoracic
Cerebral Infarction*
Female
Follow-Up Studies
Humans
Infarction, Middle Cerebral Artery
Thorax
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

• 

  Fig. 1 MR diffusion weighted images (A) and MR angiography (B) shows acute right hemispheric infarction with stenosis of the right middle cerebral artery and intracranial internal carotid artery (white arrows).

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  Fig. 2 Comparing with unremarkable initial chest X-ray (A), followed-up chest X-ray revealed mediastinal widening (B, black arrowheads).

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  Fig. 3 Carotid (A) and aorta CT angiography (B) shows that aortic dissection (Stanford A, DeBakey I) with the occlusion ofthe right common carotid artery (black arrows).

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