Successful Thrombolysis of a Stroke Patient beyond the AHA Guidelines

Case Report

Austin Neurol. 2016; 1(1): 1005.

Successful Thrombolysis of a Stroke Patient beyond the AHA Guidelines

Rana SS¹, Saini N¹, Goel D²* and Rohatgi S²

¹Resident, Max Institute of Neurosciences Dehradun (MIND), India

²Consultant Neurology, Max Institute of Neurosciences Dehradun (MIND), India

*Corresponding author: Deepak Goel, Principal Consultant Neurology, Max Institute of Neurosciences Dehradun (MIND), State Uttarakhand, India

Received: August 09, 2016; Accepted: August 31, 2016; Published: September 02, 2016


Intravenous thrombolysis is approved and a proven treatment for acute ischemic stroke in the window period of 4.5 hours. The therapeutic benefit is not extended to patients beyond the window period as they are excluded in the protocol for thrombolysis given by AHA. We report a case of successful IV thrombolysis in a 43-year-old female presented with acute onset right sided weakness and slurring of speech, 5.5 hours post onset of symptoms. She also had concurrent DVT and Pulmonary embolism. IV tissue plasminogen activator was administered 14 hours post onset of symptoms for PE. The patient’s neurological and respiratory status both improved following thrombolysis without any complications.

Keywords: Acute stroke; Thrombolysis; Guidelines

Case Report

A 43 years old right handed female, presented at around 2:11pm on 27th February, 2016 with history of acute onset, right sided weakness and slurring of speech at around 8am while climbing a hill. She felt that she was breathless, followed by light headedness and fell on the ground without any loss of consciousness. She had weakness of right side of the body and was unable to move her right upper and lower limb. She was a diagnosed case of bronchial asthma on/off medication. There was no history of diabetes mellitus, hypertension, or oral contraceptive intake. She had given history of previous 2 spontaneous abortions at less than 10 weeks of gestation.

On examination she was pale, tachypnoeic, and her extremities were cool and cyanotic with a respiratory rate of 32 per minute, a normal volume pulse of 140 beats per minute, and a blood pressure of 136/70mm Hg. She was maintaining a Spo2 of 70% on room air and 94% at 15 l of O2. On Central nervous examination, her speech was incomprehensible, right 7th upper motor neuron facial palsy and right sided hemiplegia with power of 2/5. Her NIHSS score on arrival was 15. Her MRI brain showed acute infarction in Left middle cerebral artery distribution (Figure 1). Full blood count and routine chemistry were unremarkable. Hemoglobin level was 7.4gm/dl and blood picture was suggestive of chronic hypo chromic anemia.