Stroke treatment with tissue plasminogen activator in the setting of aortic dissection

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

“…A Medline search of the English-language literature using the MeSH terms "dissecting aneurysm" and "thrombolytic therapy" or the terms "aortic dissection" and "thrombolysis" resulted in 6 reports of patients with acute aortic dissection presenting as ischemic cerebral infarction who were considered for thrombolytic therapy or inadvertently received such therapy (Table 1). [7][8][9][10][11][12] Typical risk factors for ischemic infarction, 13 including age and hypertension, were present in five of the six patients reported, [7][8][9][10][11] as well as in the present case. Undoubtedly, the presence of these traditional risk factors made it difficult for the clinician to suspect the correct diagnosis in these cases.…”

“…As in our presented case, no medical history could be elicited from the patients themselves in four of the six previously reported cases caused by decreased level of consciousness 7 or aphasia. [8][9][10] Because the most essential element in the diagnosis of acute aortic dissection is a high level of clinical suspicion and the most sensitive clue is the symptom of abrupt chest or abdominal pain, the inability of the patient to describe his symptoms is highly problematic.…”

Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke

“…17 In contrast, when patients who have ischemic stroke complicated with AAD are given rt-PA, most reports suggest that the outcome will be poor. 18, 19 In the present study, we found that d-dimer was significantly higher in patients with AAD than in patients without AAD. Importantly, d-dimer in patients with AAD was also higher than in patients without AAD within 6 h after the onset of symptoms.…”

Clinical Significance and Impact of "Painless" Acute Aortic Dissection

“…With stroke, however, many patients have no pain, which is a characteristic symptom of AAD, so dissection is not obvious from pain during the acute phase of stroke. 2,7, 8 Signs that can be observed during the clinical treatment of stroke include the following, together with the clues in Table. (1) Bradycardia In many cases, AAD comes from the ascending aorta to the right common carotid artery, and bradycardia readily occurs from the carotid reflex.…”