J Clin Neurol.  2009 Mar;5(1):49-52.

Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

Affiliations
  • 1Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea. nrhks@paik.ac.kr
  • 2Clinical Research Center, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
  • 3Department of Cardiac Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

Abstract

BACKGROUND: Acute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications.
CASE REPORT
A 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome.
CONCLUSIONS
Clinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.

Keyword

aortic dissection; ischemic stroke; thrombolysis; recombinant tissue plasminogen activator

MeSH Terms

Abdominal Pain
Emergencies
Female
Humans
Infarction, Middle Cerebral Artery
Middle Aged
Physical Examination
Stroke
Thorax
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

  • Fig. 1 CT angiography revealed no occlusion in the intracranial major arteries (A), but suggested dissection in the bilateral extracranial carotid arteries on the source images (B, black arrows). Emergent chest CT showed a Stanford type A aortic dissection (C, white arrows).

  • Fig. 2 Follow-up MRI performed 13 days postsurgery revealed small infarctions (A), but no occlusions in the extracranial and intracranial arteries (B).


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