Emerg Med J 24:594-595 doi:10.1136/emj.2007.046904
  • Emergency casebook

Ischaemic infarction masking aortic dissection: a pitfall to be avoided before thrombolysis

  1. Ju Fen Yeh1,
  2. Helen Po1,
  3. Chen Yen Chien2
  1. 1Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan
  2. 2Department of Cardiovascular Surgery, Mackay Memorial Hospital, Taipei, Taiwan
  1. Correspondence to:
 Dr Ju Fen Yeh
 No. 92, Section 2, Chungshan North Road, Taipei, Taiwan (ROC) 10448; joyce0120{at}
  • Accepted 28 January 2007


Acute aortic dissection complicated by stroke is not uncommon but may be difficult to evaluate, especially in patients with impaired mental status. We report a patient who had evidence of an ischaemic stroke but was fortuitously not given thrombolytic treatment. She was subsequently found to have an extensive aortic dissection involving both carotid arteries. The decision of whether to give thrombolytic treatment is understandably an urgent one, but careful attention should be paid to subtle signs and symptoms such as atypical chest pain and carotid bruits that might suggest aortic dissection, especially involving the carotid arteries. There should be a high index of suspicion for acute aortic dissection in such cases and a low threshold for performing carotid ultrasound.


  • Competing interests: none

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