A Hidden Catastrophe: Ruptured Abdominal Aortic Aneurysm Presenting as Acute Ischemic Stroke.

A ruptured abdominal aortic aneurysm (AAA) is a life-threatening emergency that typically presents with hypotension or abdominal pain but rarely with primary neurological deficits. We report the case of a 74-year-old woman presenting with acute focal neurological deficits concerning for ischemic stroke, whose preceding abdominal pain and lower extremity mottling ultimately pointed toward an alternative diagnosis. Point-of-care ultrasound and subsequent computed tomography angiography revealed a ruptured infrarenal AAA. We discuss how consideration of these additional clinical features led to the correct diagnosis and prevented inappropriate thrombolytic therapy. Given the time-sensitive nature of stroke management, this case highlights the importance of maintaining a broad differential diagnosis and considering aortic pathology in patients presenting with acute neurological symptoms.