Brain Disorders & Therapy

Could mismatch of clinical presentation with hyperdense MCA sign in CT and DWI findings make the decision of IV rtPA therapy for wake-up stroke (WUS)? a case report

7^th International Conference on Neurological Disorders & Stroke

September 20-21, 2018 | Rome, Italy

Isil Tatlidil and Yahya Akalin

Malatya Public Hospital, Turkey

Posters & Accepted Abstracts: Brain Disord Ther

Abstract:

Introduction: WUS is one of the relative contraindications of IV rtPA therapy in guidelines. However, recent studies suggest that using mismatch of t2 flair and DWI (Diffusion weighted imaging) could be used as tissue clock to make the decision of rtPA administration. We present a case of wake-up stroke treated with IV rtPA and endovascular intervention based on mismatch of clinical presentation-hiperdens MCA sign and DWI imaging. Case: Sixty-year-old patient presented with stuporous state, left hemiplegia, left homonym hemianopia and right hemianesthesia at arousal. Patient???s NIH score was 16+x Cranial CT revealed right hiperdens MCA Sign. However, diffusion MRI revealed acute diffusion restriction which is only in lateral lenticulostriate artery territory. IV rtPA therapy was administered 2 hour 35 minutes after the patient woke up. NIH score was 13 at the end of first hour of rtPA administration. Patient was taken to endovascular intervention. DSA (Digital subtraction) angiography showed total thrombosis if carotid artery. IV rtPA therapy was applied. After recanalization, thrombectomy of proximal middle cerebral artery was performed. Patient was discharged with m-RS 4 (Modified Rankin Scale). m-RS was 3 one month after discharge. Discussion: Studies showed that 14-24% of all strokes are WuS. And 30% of WUS could be candidate for IV rtPA through mismatch of T2 flair and DWI. Mismatch of clinical presentation, CT scan findings and DWI may also help in decision making of IV rtPA therapy.

Biography :

E-mail: tatlidilisil173@hotmail.com