Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Acute aortic dissection (AAD) is a life-threatening condition.
• Stroke is a common complication of AAD, posing diagnostic challenges, especially in patients with altered mental status.
• Thrombolytic therapy for suspected ischemic stroke carries risks in the presence of undiagnosed aortic dissection.

Purpose of the Study:

• To highlight the importance of considering AAD in patients presenting with stroke-like symptoms.
• To emphasize the diagnostic challenges and potential pitfalls in managing patients with concurrent stroke and aortic dissection.
• To advocate for a high index of suspicion and early diagnostic measures for AAD in specific clinical scenarios.

Main Methods:

• Case report presentation.
• Review of clinical presentation, diagnostic workup, and management of a patient with ischemic stroke and concurrent aortic dissection.
• Discussion of diagnostic modalities, including carotid ultrasound.

Main Results:

• The patient presented with symptoms suggestive of ischemic stroke.
• Thrombolytic treatment was withheld due to suspicion of underlying aortic pathology.
• Subsequent investigations revealed extensive aortic dissection involving the carotid arteries.

Conclusions:

• Subtle signs like atypical chest pain and carotid bruits should raise suspicion for AAD, particularly when stroke is present.
• A low threshold for carotid ultrasound is recommended in patients with suspected AAD and neurological symptoms.
• Prompt diagnosis of AAD is critical to avoid potentially fatal complications from inappropriate stroke treatment.