Open AccessChemical thrombolysis with extended 15-hour window in a patient undergoing perfusion CT scan with Rapid CT protocol: a case report
Author(s) -
Hendrick Henrique Fernandes Gramasco,
Maria Clara Foloni,
Rebeca Aranha Barbosa Sousa,
Yasmim Nadime José Frigo,
Mateus Felipe dos Santos,
Guilherme Drumond Jardini Anastácio,
Stella de Angelis Trivellato,
Daniel Fabiano Barbosa dos Santos,
Lilian Audi Goulart,
Myrian Mathildes Sá de Deus Rocha,
Natália de Castro Fim Nakao,
Gabriel Pinheiro Módolo,
Carlos Clayton Macedo de Freitas,
Rodrigo Bazan
Publication year - 2021
Language(s) - English
Resource type - Conference proceedings
DOI - 10.5327/1516-3180.516
Subject(s) - medicine , thrombolysis , hemiparesis , context (archaeology) , radiology , penumbra , modified rankin scale , stroke (engine) , middle cerebral artery , perfusion , perfusion scanning , neuroimaging , angiography , ischemia , cardiology , ischemic stroke , myocardial infarction , mechanical engineering , paleontology , psychiatry , biology , engineering
Context: Recently, with the advance of neuroimaging modalities, the windows of reperfusion therapy in patients with acute stroke have been reviewed and extended, especially for mechanical thrombectomy. Case report: 81 year old patient, previously hypertensive and dyslipidemic, fully functional (modified Rankin scale = 0), admitted to the emergency room of a tertiary hospital with global aphasia, right hemiparesis, right homonymous hemianopsia and severe hypoesthesia of the right upper limb, scoring 26 on the NIHSS, with report of having contacted family members for the last time 15 hours before admission. She was treated according to the institution’s acute stroke protocol, and underwent non-contrast brain computed tomography (CT), perfusion CT with Rapid CT protocol and cerebral artery + neck angio-CT, which ruled out bleeding and showed an ASPECTS of 8, an estimated ischemic core volume of 17 mL, and an area with hypoperfusion of 118 mL (perfusional mismatch of 101 mL), besides occlusion of the M1 segment of the left middle cerebral artery. Thus, she was submitted to chemical thrombolysis, with a decrease in NIHSS score to 15 and evolving without complications upon hospitalization. Conclusions: In patients with uncertain ictus, the use of advanced neuroimaging modalities, such as perfusion tomography with Rapid CT protocol, may assist in the indication of reperfusion therapies safely.