Abstract
Background and Purpose: A post-marketing surveillance reported fatalities following recombinant tissue plasminogen activator (rt-PA) administration among acute cerebral infarction (CI) patients with acute aortic dissection (AAD). The aim of our investigation was to seek methods for diagnosing AAD in CI patients by basic and less-invasive methods in the emergency room (ER). Methods: The study subjects consisted of 107 CI(group A) and 50 AAD patients; 13 AAD (group B) had no chest, back or abdominal pain (26%). The patients' blood pressure (BP), past history, cardiothoracic ratio (CTR) and superior mediastinum-thoracic ratio (SMTR) were extracted from medical records and supine chest radiographs obtained in the ER. Results: Seven (54%) and four (31%) patients in Group B presented with consciousness disturbance and motor deficit, respectively. There were no significant differences in the age, sex, past history or CTR between the two groups. In groups A and B, the systolic BP (mmHg) was 155 and 106, and SMTR (%) was 29 and 38, respectively, and the differences were statistically significant. Conclusions: The propriety of administration of rt-PA should be decided after careful scrutiny by chest contrast computed tomography in CI patients with hypotension or superior mediastinal enlargement in the ER.
