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

Recombinant tissue plasminogen activator (rt-PA) is effective for treating acute ischemic stroke.1 Because of the very brief time window, it is often not possible to investigate stroke etiology before administering rt-PA. There have been a number of case reports of thrombolytic therapy in patients suspected of having acute myocardial infarction who in actuality had an aortic dissection.2,3 The use of thrombolytics to treat ischemic stroke caused by an aortic dissection has not been documented. We report a patient who presented with symptoms consistent with acute ischemic stroke and was given rt-PA. Further investigation demonstrated an aortic dissection as the cause of his stroke. A 54-year-old man presented after his wife heard him fall and found him on the floor, nonverbal, unable to move his right side. There was no history of chest or back pain. Past medical history was significant for hypertension, tobacco abuse, borderline diabetes mellitus, and recent sinus surgery. On examination, he was afebrile with a blood pressure …