Journal of General Internal Medicine

, Volume 22, Issue 9, pp 1370–1372

Ischemic Stroke, Aortic Dissection, and Thrombolytic Therapy—the Importance of Basic Clinical Skills


    • Infectious Diseases, Bnai Zion Medical Center
  • Ayelet Eran
    • Radiology DepartmentRambam Medical Center
  • Alla Shifrin
    • Neurology DepartmentRambam Medical Center
Case Reports/Clinical Vignettes

DOI: 10.1007/s11606-007-0269-2

Cite this article as:
Grupper, M., Eran, A. & Shifrin, A. J GEN INTERN MED (2007) 22: 1370. doi:10.1007/s11606-007-0269-2


Aortic dissection masquerading as ischemic stroke is particularly challenging in the era of thrombolysis as a result of narrow diagnostic time window and severe hemorrhagic potential. We describe a case of a 77-year-old patient with a presumed ischemic cerebral infarct, in whom planned treatment with tissue plasminogen activator therapy (TPA) was withheld because of partial spontaneous improvement in his condition. Shortly afterwards, newly elicited clues in the medical history and physical examination led to timely diagnosis and treatment of ascending thoracic aorta dissection, which was the underlying disorder. Analysis of the features of this case and similar previously published cases illustrates the importance of using and mastering basic diagnostic skills.


aortic dissectionstrokethrombolysis

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© Society of General Internal Medicine 2007