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Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills

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Abstract

Aortic dissection masquerading as ischemic stroke is particularly challenging in the era of thrombolysis as a result of narrow diagnostic time window and severe hemorrhagic potential. We describe a case of a 77-year-old patient with a presumed ischemic cerebral infarct, in whom planned treatment with tissue plasminogen activator therapy (TPA) was withheld because of partial spontaneous improvement in his condition. Shortly afterwards, newly elicited clues in the medical history and physical examination led to timely diagnosis and treatment of ascending thoracic aorta dissection, which was the underlying disorder. Analysis of the features of this case and similar previously published cases illustrates the importance of using and mastering basic diagnostic skills.

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Acknowledgements

We thank Israel Potasman, MD, whose mentoring was invaluable for the preparation of the manuscript and Richard Lincoln for proofreading of the manuscript.

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Infectious Diseases, Bnai Zion Medical Center, P.O. Box 4940, Haifa, 31048, Israel

    Moti Grupper

  2. Radiology Department, Rambam Medical Center, Haifa, Israel

    Ayelet Eran

  3. Neurology Department, Rambam Medical Center, Haifa, Israel

    Alla Shifrin

Authors
  1. Moti Grupper
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  2. Ayelet Eran
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  3. Alla Shifrin
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Correspondence to Moti Grupper.

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Grupper, M., Eran, A. & Shifrin, A. Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills. J GEN INTERN MED 22, 1370–1372 (2007). https://doi.org/10.1007/s11606-007-0269-2

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  • DOI: https://doi.org/10.1007/s11606-007-0269-2

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