Successful Delayed Aortic Surgery for a Patient with Ischemic Stroke Secondary to Aortic Dissection

The diagnosis of aortic dissection (AD) is sometimes difficult within the limited time window of recombinant tissue plasminogen activator (tPA) for ischemic stroke (IS). A 60-year-old man developed sudden left hemiparesis due to IS. During tPA infusion, his blood pressure dropped and consciousness d...

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Published inInternal Medicine Vol. 56; no. 17; pp. 2343 - 2346
Main Authors Morihara, Ryuta, Yamashita, Toru, Deguchi, Kentaro, Tsunoda, Keiichiro, Manabe, Yasuhiro, Takahashi, Yoshiaki, Yunoki, Taijun, Sato, Kota, Nakano, Yumiko, Kono, Syoichiro, Ohta, Yasuyuki, Hishikawa, Nozomi, Abe, Koji
Format Journal Article
LanguageEnglish
Published Japan The Japanese Society of Internal Medicine 01.09.2017
Japan Science and Technology Agency
Subjects
Aneurysm, Dissecting - complications
Aneurysm, Dissecting - surgery
Aneurysms
Aorta
Aortic dissection
Blood pressure
Case Report
Diagnosis
Dissection
Emergency medical services
Hemorrhage
hemorrhagic transformation
Humans
Internal medicine
Ischemia
Ischemic Attack, Transient - etiology
Ischemic Attack, Transient - surgery
ischemic stroke
Male
Middle Aged
Paresis
recombinant tissue plasminogen activator
Surgery
t-Plasminogen activator
Time Factors
Treatment Outcome
Ultrasound
recombinant tissue plasminogen activator
hemorrhagic transformation
aortic dissection
ischemic stroke
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Summary:The diagnosis of aortic dissection (AD) is sometimes difficult within the limited time window of recombinant tissue plasminogen activator (tPA) for ischemic stroke (IS). A 60-year-old man developed sudden left hemiparesis due to IS. During tPA infusion, his blood pressure dropped and consciousness declined. After transfer to our hospital, carotid duplex ultrasonography led to a diagnosis of AD. Emergency surgery was postponed because of the risk of hemorrhagic transformation. The patient successfully underwent aortic surgery on day 5 and was discharged with a remarkable improvement in his symptoms. Delayed surgery may avoid hemorrhagic transformation in patients with AD-induced IS who have received tPA.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ObjectType-Report-1
ObjectType-Article-3
Correspondence to Dr.　Koji Abe, p2k07ll9@cc.okayama-u.ac.jp
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.8438-16