Repeat intravenous r-tPA administration four days after initial thrombolytic therapy for recurrent ischemic stroke: A case report and review of literature

Document Type

Article

Publication Date

1-3-2021

Publication Title

Interdisciplinary Neurosurgery

Abstract

Stroke is a significant source of morbidity and mortality within the United States. The current standard of care for treatment of acute ischemic stroke is intravenous recombinant tissue-type plasminogen activator (IV r-tPA). However, IV r-tPA is contraindicated within 3 months of a previous stroke due to concern for symptomatic intracerebral hemorrhage (sICH). We describe the case of a 77-year-old female who developed aphasia and rightsided quadrantanopsia and was found to have a calcified embolus in the M3 branch of her left middle cerebral artery. She was given IV r-tPA with subsequent symptom resolution and no MRI evidence of acute or subacute infarct. 4 days after index stroke, she had recurrence of her symptoms, receiving a second dose of IV r-tPA. She improved clinically. Non-contrast CT 24 hours afterwards showed minimal foci of intraparenchymal hemorrhage without midline shift or mass effect. She remained neurologically stable and improved significantly with inpatient rehabilitation.

Volume

23

First Page

100937

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