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Updated: Jan 26, 2026
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Thrombolysis for atlantoaxial dislocation mimicking acute ischemic stroke
Adam Tsou1, Yu-Hsiu Juan2, Tsu-Yi Chen3
1Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan.
The American Journal of Emergency Medicine
|April 4, 2019
Summary
Atlantoaxial dislocation can mimic stroke symptoms, leading to rare cases of thrombolytic therapy for spinal cord compression. This condition, though rare, may not be harmed by thrombolysis, emphasizing careful neurological evaluation.
Area of Science:
- Neurology
- Neurosurgery
- Emergency Medicine
Background:
- Stroke mimics are common, occurring in up to 30% of stroke patients.
- Thrombolytic therapy is a critical treatment for acute ischemic stroke.
- Atlantoaxial dislocation presenting as a stroke mimic is exceedingly rare.
Observation:
- An 83-year-old man experienced acute left hemiplegia after chiropractic neck manipulation.
- He received intravenous thrombolytic therapy for suspected stroke.
- Subsequent development of Brown-Sequard syndrome indicated cervical spinal cord compression from atlantoaxial dislocation.
Findings:
- Brain imaging revealed atlantoaxial dislocation causing spinal cord compression, not acute cerebral infarct.
- The patient's condition did not worsen after thrombolysis.
- Surgical decompression led to gradual motor improvement.
Implications:
- Atlantoaxial dislocation can present with hemiplegia, mimicking acute stroke.
- Inadvertent thrombolytic therapy may be safe in atlantoaxial dislocation-induced cervical myelopathy.
- Continuous neurological assessment is crucial to distinguish stroke from myelopathy.
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