Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 3735  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  » Next article
  » Previous article 
  » Table of Contents
  
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
  »  Article in PDF (579 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

 
  In this Article
 »  References
 »  Article Figures

 Article Access Statistics
    Viewed2046    
    Printed91    
    Emailed1    
    PDF Downloaded71    
    Comments [Add]    
    Cited by others 11    

Recommend this journal

 


 
LETTER TO EDITOR
Year : 2009  |  Volume : 57  |  Issue : 6  |  Page : 808-809

Administration of recombinant tissue plasminogen activator to a case of cerebral infarction in the setting of painless aortic dissection


Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Japan

Date of Acceptance12-May-2009
Date of Web Publication30-Jan-2010

Correspondence Address:
Satoru Takeuchi
Department of Neurosurgery, National Hospital Organization Disaster Medical Center
Japan
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.59487

Rights and Permissions



How to cite this article:
Takeuchi S, Takasato Y, Masaoka H, Otani N. Administration of recombinant tissue plasminogen activator to a case of cerebral infarction in the setting of painless aortic dissection. Neurol India 2009;57:808-9

How to cite this URL:
Takeuchi S, Takasato Y, Masaoka H, Otani N. Administration of recombinant tissue plasminogen activator to a case of cerebral infarction in the setting of painless aortic dissection. Neurol India [serial online] 2009 [cited 2019 Oct 22];57:808-9. Available from: http://www.neurologyindia.com/text.asp?2009/57/6/808/59487


Sir,

A 72-year-old female presented with acute onset left sided hemiparesis. On admission, a physical examination revealed a consciousness level of 15 on the Glasgow coma scale, blood pressure of 160/116 mmHg, and pulse rate of 51 per minute. Radial and femoral pulses were normal. Patient had left hmeparesis and National Institutes of Health Stroke Scale (NIHSS) score was 16. She did not complain any chest, abdominal and back pain. Chest X-ray, an electrocardiogram and brain computed tomography (CT) showed no abnormal findings. Brain magnetic resonance imaging (MRI) revealed a right middle cerebral artery territory infarct [Figure 1]a and b. Brain MR angiography demonstrated an occlusion of right carotid artery [Figure 1]c. Laboratory studies were within normal limits. One hundred and forty-four min after onset, the patient received recombinant tissue plasminogen activator (rt-PA), 39 mg (0.6 mg/kg). On Day 2, vital signs were stable and follow-up CT showed no hemorrhagic change. However, on Day 3, the patient suffered a sudden cardiac arrest from which she could not be resuscitated. Autopsy revealed a Stanford Type A aortic dissection (AD) and cardiac tamponade [Figure 1]d. There was also dissection of the right common carotid artery [Figure 1]d and e.

Thrombolysis with rt-PA has been done in the setting of painless AD. [1] In our patient it is quite possible that the administration of rt-PA might have contributed to the death of the patient by the lysis of the thrombus that would otherwise have limited the dissection. Because AD is a rare cause of stroke, there is debate about the necessity to aggressively screen for AD.

Although pain in the chest, back, or abdomen is a common symptom in AD, approximately 10% of patients experience no pain. [2],[3],[4],[5] Pulse and blood pressure differences and abnormal chest radiograms can be useful for the rapid assessment of AD. However, approximately 7% of AD patients show normal findings. [2] Color duplex ultrasound is a simple tool to exclude painless AD and cervical artery dissection. [3],[4] Chest CT scanning and transesophageal echocardiography, while very sensitive for AD, are time-consuming and expensive. [2],[3],[4]

Strokes associated with AD are predominantly right hemispheric. [5] This dominance could be explained by varying mechanical dynamics in the progression of the dissecting hematoma. We believe a high index of suspicion of painless AD would be advisable and also a lower threshold for performing carotid ultrasound before rt-PA treatment, especially in patients with right hemispheric infarct.

 
 » References Top

1.Fessler AJ, Alberts MJ. Stroke treatment with tissue plasminogen activator in the setting of aortic dissection. Neurology 2000;54:1010.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.von Kodolitsch Y, Schwartz AG, Nienaber CA. Clinical prediction of acute aortic dissection. Arch Intern Med 2000 23;160:2977-82.  Back to cited text no. 2      
3.Veyssier-Belot C, Cohen A, Rougemont D, Levy C, Amarenco P, Bousser MG. Cerebral infarction due to painless thoracic aortic and common carotid artery dissections. Stroke 1993;24:2111-3.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Benninger DH, Georgiadis D, Gandjour J, Baumgartner RW. Accuracy of color duplex ultrasound diagnosis of spontaneous carotid dissection causing ischemia. Stroke 2006;37:377-81.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Gaul C, Dietrich W, Friedrich I, Sirch J, Erbguth FJ. Neurological symptoms in type A aortic dissections. Stroke 2007;38:292-7.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1]

This article has been cited by
1 Successful Delayed Aortic Surgery for a Patient with Ischemic Stroke Secondary to Aortic Dissection
Ryuta Morihara,Toru Yamashita,Kentaro Deguchi,Keiichiro Tsunoda,Yasuhiro Manabe,Yoshiaki Takahashi,Taijun Yunoki,Kota Sato,Yumiko Nakano,Syoichiro Kono,Yasuyuki Ohta,Nozomi Hishikawa,Koji Abe
Internal Medicine. 2017; 56(17): 2343
[Pubmed] | [DOI]
2 Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions
Georgios Tsivgoulis,Apostolos Safouris,Andrei V Alexandrov
Expert Opinion on Drug Safety. 2015; 14(6): 845
[Pubmed] | [DOI]
3 Aortic Dissection as a Possible Underlying Cause of Acute Ischemic Stroke
Masahiro Kamouchi
Circulation Journal. 2015; 79(8): 1697
[Pubmed] | [DOI]
4 Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: a retrospective study
Seung-Jae Lee,Jae-Hyun Kim,Chan-Young Na,Sam-Sae Oh,Yang-Min Kim,Chang-Keun Lee,Dal-Soo Lim
BMC Neurology. 2013; 13(1): 46
[Pubmed] | [DOI]
5 Eleven years of experience with the neurologic complications in Korean patients with acute aortic dissection: A retrospective study
Lee, S.-J. and Kim, J.-H. and Na, C.-Y. and Oh, S.-S. and Kim, Y.-M. and Lee, C.-K. and Lim, D.-S.
BMC Neurology. 2013; 13(46)
[Pubmed]
6 Ischemic stroke related to pauci-symptomatic acute aortic dissection. Risks of intravenous thrombolysis [Infarctus cérébral par dissection aortique pauci-symptomatique. Les risques de la thrombolyse, à propos de deux observations]
Folgoas, E. and Toulgoat, F. and Sévin, M. and Boutoleau-Bretonnière, C. and Guillon, B.
Revue Neurologique. 2012; 168(4): 357-362
[Pubmed]
7 Infarctus cérébral par dissection aortique pauci-symptomatique. Les risques de la thrombolyse, à propos de deux observations
E. Folgoas,F. Toulgoat,M. Sévin,C. Boutoleau-Bretonnière,B. Guillon
Revue Neurologique. 2012; 168(4): 357
[Pubmed] | [DOI]
8 Aortic Dissection Complicated with Fatal Cerebral Infarction: Case Report and Review of Literatures
Kentaro Hayashi,Nobutaka Horie,Kazuhiko Suyama,Izumi Nagata
Open Journal of Modern Neurosurgery. 2012; 02(02): 21
[Pubmed] | [DOI]
9 Excluding Aortic Dissection Before Thrombolysis in Patients with Ischemic Stroke Has Been Insufficiently Advised
Koracevic P. Goran
Journal of Stroke and Cerebrovascular Diseases. 2011; 20(4): 384
[Pubmed] | [DOI]
10 Excluding aortic dissection before thrombolysis in patients with ischemic stroke has been insufficiently advised
Goran, K.P.
Journal of Stroke and Cerebrovascular Diseases. 2011; 20(4): 384
[Pubmed]
11 Acute ischemic stroke in aortic dissection: Case report and review of literature
Ramalingam, V.S. and Sinnakirouchenan, R. and Sudhakar, S. and Brasch, A.V.
Indian Journal of Medical Sciences. 2010; 64(8): 385-389
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow