title: Intravenous thrombolysis in an elderly patient with acute ischemic stroke masking aortic dissection.
abstract: 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.
authors.affiliation: Stroke Unit, Department of Neurology, Castellón General Hospital, Av. Benicàssim S/N, Castellón, Spain. rodriguezlunad@yahoo.es
authors.forename: David
authors.initials: D
authors.lastname: Rodríguez-Luna
authors.forename: Rosa María
authors.initials: RM
authors.lastname: Vilar
authors.forename: Manuel
authors.initials: M
authors.lastname: Peinazo
authors.forename: Ana
authors.initials: A
authors.lastname: del Villar
authors.forename: Berta
authors.initials: B
authors.lastname: Claramonte
authors.forename: Carlos
authors.initials: C
authors.lastname: Vilar
authors.forename: Daniel
authors.initials: D
authors.lastname: Geffner
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator