Advertisement

When stroke is more than stroke

Published:November 18, 2015DOI:https://doi.org/10.1016/j.ajem.2015.11.033
      “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.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • DeBakey M.E.
        • McCollum C.H.
        • Crawford E.S.
        • Morris Jr, GC
        • Howell J
        • Noon GP
        • et al.
        Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically.
        Surgery. 1982; 92: 1118-1134
        • Rodriguez-Luna D.
        • Vilar R.M.
        • Peinazo M.
        • del Villar A
        • Claramonte B
        • Vilar C
        • et al.
        Intravenous thrombolysis in an elderly patient with acute ischemic stroke masking aortic dissection.
        J Stroke Cerebrovasc Dis. 2011; 20: 559-561
        • Tsivgoulis G.
        • Vadikolias K.
        • Heliopoulos I.
        • Patousi A
        • Iordanidis A
        • Souftas V
        • et al.
        Aortic arch dissection causing acute cerebral ischemia: an uncommon contraindication for intravenous thrombolysis.
        Circulation. 2011; 124: 657-658
        • Hayashi K.
        • Horie N.
        • Suyama K.
        • Nagata I.
        Aortic dissection complicated with fatal cerebral infarction: case report and review of literatures.
        Open J Mod Neurosurg. 2012; 02: 4