Stroke treatment with tissue plasminogen activator in the setting of aortic dissection

[Doppler sonography suggesting fulminant aortic dissection in initial middle cerebral artery infarction]

Acute aortic dissection is a cardiovascular emergency with a wide spectrum of clinical symptoms making the diagnosis difficult if the leading symptom of thoracic pain is not present. In up to 10% of cases an ischemic stroke may be the first clinical sign. We report a patient with a middle cerebral artery infarction in whom an abnormal signal in the extracranial Doppler sonography revealed the first hint of an aortic dissection. Before the diagnosis could be verified, the patient died due to electromechanical decoupling; autopsy showed an extensive aortic dissection with cardiac tamponade. Based on this case report, we review special problems of diagnosis and therapy in aortic dissection with primary cerebrovascular manifestation.