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

doi:10.2169/internalmedicine.8438-16

CASE REPORTS

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

Author information

Ryuta Morihara
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Toru Yamashita
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Kentaro Deguchi
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Keiichiro Tsunoda
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Yasuhiro Manabe
Department of Neurology, Okayama National Hospital Medical Center, Japan
Yoshiaki Takahashi
Department of Neurology, Okayama National Hospital Medical Center, Japan
Taijun Yunoki
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Kota Sato
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Yumiko Nakano
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Syoichiro Kono
Department of Neurology, Okayama National Hospital Medical Center, Japan
Yasuyuki Ohta
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Nozomi Hishikawa
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan
Koji Abe
Departments of Neurology, Dentistry, and Pharmaceutical Sciences, Graduate School of Medicine, Okayama University, Japan

Keywords: aortic dissection, hemorrhagic transformation, ischemic stroke, recombinant tissue plasminogen activator

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 17 Pages 2343-2346

DOI https://doi.org/10.2169/internalmedicine.8438-16

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Abstract

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.

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