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Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

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초록

BackgroundaaAcute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. Case ReportaaA 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome. ConclusionsaaClinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.

Abstract

BackgroundaaAcute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. Case ReportaaA 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome. ConclusionsaaClinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.

참고문헌 (12)

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  2. Adams HP Jr, "Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association", American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists, 2007, pp.38, 1655~1711
  3. Kamp TJ, "Myocardial infarction, aortic dissection, and thrombolytic therapy", Am Heart J, 128, pp.1234~1237 (1994)
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  5. Ibaraki T, "Surgical management of acute type A aortic dissection with a complaint of disturbance of consciousness; report of a case", Kyobu Geka, 55, pp.1053~1056 (2002)
  6. Chua CH, "Emergency surgical intervention in a patient with delayed diagnosis of aortic dissection presenting with acute ischemic stroke and undergoing thrombolytic therapy", J Thorac Cardiovasc Surg, 130, pp.1222~1224 (2005)
  7. Uchino K, "Aortic dissection presenting as an acute ischemic stroke for thrombolysis", J Neuroimaging, 15, pp.281~283 (2005)
  8. Flemming KD, "Acute cerebral infarction caused by aortic dissection: caution in the thrombolytic era", Stroke, 30, pp.477~478 (1999)
  9. Villa A, "Acute ischemic stroke, aortic dissection, and thrombolytic therapy", Am J Emerg Med, 21, pp.159~160 (2003)
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  11. Grupper M, "Ischemic stroke, aortic dissection, and thrombolytic therapy--the importance of basic clinical skills", J Gen Intern Med, 22, pp.1370~1372 (2007)
  12. Yeh JF, "Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis", Emerg Med J, 24, pp.594~595 (2007)

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