Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

Abstract

We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding.

Successful intravenous thrombolysis for acute ischemic stroke caused by aortic dissection with severe hypofibrinogenemia: a case report and literature review

“…Patients with AD are prone to unstable hemodynamics [8], such as BP difference >20 mmHg between both arms and nonpalpable weak pulse on one side [9]. Typical patients with AD often have chest/back/ abdominal pain, but our patient had no chest/back pain during hospitalization.…”

“…Choi et al [8] Jo et al [4] Do et al [12] Rodr ıguez-Luna et al [9] Hong et al [14] Kazmi et al [ dysphrasia can obscure the symptoms of AD, resulting in misdiagnosis of AD [11].…”

Type A acute aortic dissection presenting as a stroke in a young male patient

“…He was able to undergo surgery as soon as he was transferred to a higher level of care hospital. Although many patients tend to have increased bleeding, no consensus exists regarding the optimal timing for major cardiac surgery after the administration of tPA 4…”

“…Major brain injury at the onset of dissection is not such a rare complication in patients diagnosed with type A AAD, presenting a challenge to the diagnosing physician. We still lack information on how these patients’ management with the initial presentation of stroke should be 3 4. The vast array of non-specific presentations we encounter in patients with AAD represents a challenge to physicians, specifically in a disease that, if left untreated, associates a mortality rate of 1–2% per hour during the first 48 hours 1…”