Intravenous thrombolysis in an elderly patient with acute ischemic stroke masking aortic dissection.
Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. After IV tPA infusion was started, carotid color-coded duplex sonography demonstrated proximal left common carotid artery dissection suggestive of AAD. Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered.
Rodríguez-Luna
David
D
Stroke Unit, Department of Neurology, Castellón General Hospital, Av. Benicàssim S/N, Castellón, Spain. rodriguezlunad@yahoo.es
Vilar
Rosa María
RM
Peinazo
Manuel
M
del Villar
Ana
A
Claramonte
Berta
B
Vilar
Carlos
C
Geffner
Daniel
D
D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis; D001014:Aortic Aneurysm / Q000150:complications* / Q000175:diagnosis; D001027:Aortography / Q000379:methods; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator