Intravenous Thrombolysis in an Elderly Patient With Acute Ischemic Stroke Masking Aortic Dissection
Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of...
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| Veröffentlicht in: | Journal of stroke and cerebrovascular diseases 2011-11, Vol.20 (6), p.559-561 |
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| container_title | Journal of stroke and cerebrovascular diseases |
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| creator | Rodríguez-Luna, David, MD Vilar, Rosa María, MD Peinazo, Manuel, MD del Villar, Ana, MD Claramonte, Berta, MD Vilar, Carlos, MD Geffner, Daniel, MD |
| description | Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. After IV tPA infusion was started, carotid color-coded duplex sonography demonstrated proximal left common carotid artery dissection suggestive of AAD. Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered. |
| doi_str_mv | 10.1016/j.jstrokecerebrovasdis.2010.02.023 |
| format | Article |
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We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. After IV tPA infusion was started, carotid color-coded duplex sonography demonstrated proximal left common carotid artery dissection suggestive of AAD. Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered.</description><identifier>ISSN: 1052-3057</identifier><identifier>EISSN: 1532-8511</identifier><identifier>DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.023</identifier><identifier>PMID: 20833084</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute stroke ; Aged, 80 and over ; Aneurysm, Dissecting - complications ; Aneurysm, Dissecting - diagnosis ; Aortic Aneurysm - complications ; Aortic Aneurysm - diagnosis ; Aortography - methods ; Brain Ischemia - diagnosis ; Brain Ischemia - drug therapy ; Brain Ischemia - etiology ; Cardiovascular ; Fatal Outcome ; Female ; Fibrinolytic Agents - administration & dosage ; Humans ; Infusions, Intravenous ; Neurology ; neurosonology ; Stroke - diagnosis ; Stroke - drug therapy ; Stroke - etiology ; Thrombolytic Therapy ; tissue plasminogen activator ; Tissue Plasminogen Activator - administration & dosage ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography, Doppler, Color</subject><ispartof>Journal of stroke and cerebrovascular diseases, 2011-11, Vol.20 (6), p.559-561</ispartof><rights>National Stroke Association</rights><rights>2011 National Stroke Association</rights><rights>Copyright © 2011 National Stroke Association. 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All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-7bfabf83be4835a2cc7acbbce3a55b507cc8ac0f7b0006b582fc70f90a9274a53</citedby><cites>FETCH-LOGICAL-c458t-7bfabf83be4835a2cc7acbbce3a55b507cc8ac0f7b0006b582fc70f90a9274a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1052305710000881$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20833084$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodríguez-Luna, David, MD</creatorcontrib><creatorcontrib>Vilar, Rosa María, MD</creatorcontrib><creatorcontrib>Peinazo, Manuel, MD</creatorcontrib><creatorcontrib>del Villar, Ana, MD</creatorcontrib><creatorcontrib>Claramonte, Berta, MD</creatorcontrib><creatorcontrib>Vilar, Carlos, MD</creatorcontrib><creatorcontrib>Geffner, Daniel, MD</creatorcontrib><title>Intravenous Thrombolysis in an Elderly Patient With Acute Ischemic Stroke Masking Aortic Dissection</title><title>Journal of stroke and cerebrovascular diseases</title><addtitle>J Stroke Cerebrovasc Dis</addtitle><description>Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. After IV tPA infusion was started, carotid color-coded duplex sonography demonstrated proximal left common carotid artery dissection suggestive of AAD. Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered.</description><subject>Acute stroke</subject><subject>Aged, 80 and over</subject><subject>Aneurysm, Dissecting - complications</subject><subject>Aneurysm, Dissecting - diagnosis</subject><subject>Aortic Aneurysm - complications</subject><subject>Aortic Aneurysm - diagnosis</subject><subject>Aortography - methods</subject><subject>Brain Ischemia - diagnosis</subject><subject>Brain Ischemia - drug therapy</subject><subject>Brain Ischemia - etiology</subject><subject>Cardiovascular</subject><subject>Fatal Outcome</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration & dosage</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Neurology</subject><subject>neurosonology</subject><subject>Stroke - diagnosis</subject><subject>Stroke - drug therapy</subject><subject>Stroke - etiology</subject><subject>Thrombolytic Therapy</subject><subject>tissue plasminogen activator</subject><subject>Tissue Plasminogen Activator - administration & dosage</subject><subject>Tomography, X-Ray Computed</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Doppler, Color</subject><issn>1052-3057</issn><issn>1532-8511</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqVkVGLEzEQxxdRvPP0K0jeBGHrZLPppi9CPc-7QkXhTnwMyeyszXa7uUuyhX57U3v6IL4IAxnCf_4z85uieMthxoHP3_WzPqbgt4QUyAa_N7F1cVZBFkCVQzwpzrkUVakk509zDrIqBcjmrHgRYw_AuVTyeXFWgRICVH1e4GpMwexp9FNkd5vgd9YPh-gicyMzI7saWgrDgX01ydGY2HeXNmyJUyK2irihnUN2-2so9tnErRt_sKUPKf9-dDESJufHl8WzzgyRXj2-F8W3T1d3lzfl-sv16nK5LrGWKpWN7YztlLBUKyFNhdgYtBZJGCmthAZRGYSusQAwt1JVHTbQLcAsqqY2UlwUb06-98E_TBST3rmINAxmpLyeXkANsGj4PCs_nJQYfIyBOn0f3M6Eg-agj6x1r__FWh9Za6hyiGzy-rHdZHfU_rH4DTcL1icB5aX3joKOmCEitS5kMrr17v_6vf_LDgc3OjTDlg4Uez-FMePVXMdcoG-P1z8en2dcoBQXPwE2ZrVm</recordid><startdate>20111101</startdate><enddate>20111101</enddate><creator>Rodríguez-Luna, David, MD</creator><creator>Vilar, Rosa María, MD</creator><creator>Peinazo, Manuel, MD</creator><creator>del Villar, Ana, MD</creator><creator>Claramonte, Berta, MD</creator><creator>Vilar, Carlos, MD</creator><creator>Geffner, Daniel, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20111101</creationdate><title>Intravenous Thrombolysis in an Elderly Patient With Acute Ischemic Stroke Masking Aortic Dissection</title><author>Rodríguez-Luna, David, MD ; Vilar, Rosa María, MD ; Peinazo, Manuel, MD ; del Villar, Ana, MD ; Claramonte, Berta, MD ; Vilar, Carlos, MD ; Geffner, Daniel, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-7bfabf83be4835a2cc7acbbce3a55b507cc8ac0f7b0006b582fc70f90a9274a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acute stroke</topic><topic>Aged, 80 and over</topic><topic>Aneurysm, Dissecting - complications</topic><topic>Aneurysm, Dissecting - diagnosis</topic><topic>Aortic Aneurysm - complications</topic><topic>Aortic Aneurysm - diagnosis</topic><topic>Aortography - methods</topic><topic>Brain Ischemia - diagnosis</topic><topic>Brain Ischemia - drug therapy</topic><topic>Brain Ischemia - etiology</topic><topic>Cardiovascular</topic><topic>Fatal Outcome</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration & dosage</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Neurology</topic><topic>neurosonology</topic><topic>Stroke - diagnosis</topic><topic>Stroke - drug therapy</topic><topic>Stroke - etiology</topic><topic>Thrombolytic Therapy</topic><topic>tissue plasminogen activator</topic><topic>Tissue Plasminogen Activator - administration & dosage</topic><topic>Tomography, X-Ray Computed</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Doppler, Color</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodríguez-Luna, David, MD</creatorcontrib><creatorcontrib>Vilar, Rosa María, MD</creatorcontrib><creatorcontrib>Peinazo, Manuel, MD</creatorcontrib><creatorcontrib>del Villar, Ana, MD</creatorcontrib><creatorcontrib>Claramonte, Berta, MD</creatorcontrib><creatorcontrib>Vilar, Carlos, MD</creatorcontrib><creatorcontrib>Geffner, Daniel, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of stroke and cerebrovascular diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodríguez-Luna, David, MD</au><au>Vilar, Rosa María, MD</au><au>Peinazo, Manuel, MD</au><au>del Villar, Ana, MD</au><au>Claramonte, Berta, MD</au><au>Vilar, Carlos, MD</au><au>Geffner, Daniel, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intravenous Thrombolysis in an Elderly Patient With Acute Ischemic Stroke Masking Aortic Dissection</atitle><jtitle>Journal of stroke and cerebrovascular diseases</jtitle><addtitle>J Stroke Cerebrovasc Dis</addtitle><date>2011-11-01</date><risdate>2011</risdate><volume>20</volume><issue>6</issue><spage>559</spage><epage>561</epage><pages>559-561</pages><issn>1052-3057</issn><eissn>1532-8511</eissn><abstract>Before thrombolytic treatment for acute ischemic stroke is undertaken, conditions associated with increased risk of hemorrhagic complications, such as an acute aortic dissection (AAD), should be excluded. We report an 80-year-old woman with acute ischemic stroke as the sole clinical manifestation of AAD who was treated with intravenous (IV) tissue plasminogen activator (tPA). She had no history of hypertension or any signs or symptoms suggestive of AAD. After IV tPA infusion was started, carotid color-coded duplex sonography demonstrated proximal left common carotid artery dissection suggestive of AAD. Infusion of tPA was stopped, and subsequent computed tomography angiography confirmed Stanford type A aortic dissection. In this case, prompt neurosonologic evaluation helped us make an appropriate diagnosis and avoid complications related to treatment. Neurosonologic evaluation should be considered as soon as possible in all patients with acute ischemic stroke, especially when thrombolytic treatment is being considered.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>20833084</pmid><doi>10.1016/j.jstrokecerebrovasdis.2010.02.023</doi><tpages>3</tpages></addata></record> |
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| subjects | Acute stroke Aged, 80 and over Aneurysm, Dissecting - complications Aneurysm, Dissecting - diagnosis Aortic Aneurysm - complications Aortic Aneurysm - diagnosis Aortography - methods Brain Ischemia - diagnosis Brain Ischemia - drug therapy Brain Ischemia - etiology Cardiovascular Fatal Outcome Female Fibrinolytic Agents - administration & dosage Humans Infusions, Intravenous Neurology neurosonology Stroke - diagnosis Stroke - drug therapy Stroke - etiology Thrombolytic Therapy tissue plasminogen activator Tissue Plasminogen Activator - administration & dosage Tomography, X-Ray Computed Treatment Outcome Ultrasonography, Doppler, Color |
| title | Intravenous Thrombolysis in an Elderly Patient With Acute Ischemic Stroke Masking Aortic Dissection |
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