Acute Cerebral Infarction Caused by Aortic Dissection: Caution in the Thrombolytic Era

To the Editor: The National Institute of Neurological Disorders and Stroke (NINDS) Acute Ischemic Stroke Trial1 has brought treatment of acute ischemic stroke into the thrombolytic era.2 The inclusion and exclusion criteria were established to provide guidelines for the safe treatment of ischemic stroke within the first 3 hours.Case: A 72-year-old woman was noted to drive off the road at 9:45 pm, with her car traveling at approximately 10 miles per hour. When they arrived minutes later, emergency medical services noted that the woman had a left facial droop and left hemiparesis. She arrived at the emergency department 20 minutes later. On initial evaluation, her temperature was 36.1°C, blood pressure 130/80 mm Hg, and pulse 54 and regular. She alerted to voice and could follow simple commands intermittently. She had minimal verbal output, except for perseveration of the word “hello.” Cranial nerve examination was significant for a left upper motor neuron facial droop and right gaze preference. She had a …