Ischemic stroke related to pauci-symptomatic acute aortic dissection. Risks of intravenous thrombolysis

Introduction. Acute aortic dissection involving the cervical arteries often induces cerebral infarction. In this context, there is a high risk of hemorrhage and thrombolytics are contraindicated. Observation. We report two patients with a cerebral infarction which occurred after a pauci-symptomatic and undiagnosed aortic dissection treated with thrombolysis. The outcome was poor for both patients. Discussion. Ischemic strokes related to acute aortic dissection often involve the right carotid artery territory and may manifest without pain. A systematic assessment of supra-aortic arteries might help to identify the underlying diagnosis. Conclusion. Acute aortic dissection should be systematically mentioned in the management of the acute ischemic stroke. (C) 2012 Elsevier Masson SAS. All rights reserved.