When stroke is more than stroke

Published:November 18, 2015DOI:
      “Time is brain” captures the essence of treating acute stroke. The diagnosis must be confidently established, whereas contraindications for thrombolysis must be excluded in a timely manner. However, stroke mimics always pose a challenge. We describe a case of aortic dissection presenting as right middle cerebral artery syndrome who received intravenous thrombolysis complicated by aortic rupture with a fatal outcome. A Medline search shows that this is the first report of aortic rupture since the inception of thrombolysis for acute stroke. The emerging application of point-of-care carotid ultrasonography may identify these patients before thrombolysis.
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