Key result
A patient presenting with ischaemic stroke was found to have an extensive aortic dissection involving both carotid arteries, highlighting the need for careful evaluation before thrombolysis.
Case Report (n=1)
Careful clinical evaluation for subtle signs of aortic dissection, such as atypical chest pain and carotid bruits, is crucial before administering thrombolysis for acute ischemic stroke.
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Aortic dissection may mimic stroke and preclude thrombolysis; this case extends known presentations but leaves broader screening open.
Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. This report describes a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. She was subsequently found to have an extensive aortic dissection involving both carotid arteries. The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound.
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Yeh et al. (2009) conducted a case report in Acute aortic dissection complicated by ischaemic stroke (n=1). Thrombolytic treatment (withheld) was evaluated. A patient presenting with ischaemic stroke was found to have an extensive aortic dissection involving both carotid arteries, highlighting the need for careful evaluation before thrombolysis.
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