Management of Acute Ischemic Stroke in a Patient with a Past History of Intracranial Hemorrhage

• 作者: Fatimah Al Zawad Ghadeer Al-Shabeeb Osama Basheir
• 来源期刊: 神经系统科学与医药(英文)
• 学科: 医学
• 关键词: ISCHEMIC STROKE Acute ISCHEMIC STROKE IVtPA in HISTORY of HEMORRHAGIC STROKE HEMORRHAGIC STROKE INTRAVENOUS THROMBOLYSIS
• 年，卷（期）: 2020,（1）
• 页码范围: 29-35
• 页数: 7页
• 分类号: R74

摘要

Intravenous thrombolysis remains the gold standard in the management of acute ischemic stroke if the patient presents within the window period. Endovascular thrombectomy is another line of therapy in selected cases. Nonetheless, one of the most devastating complications of IV thrombolysis is intracranial hemorrhage (ICH);in such cases, the previous history of ICH is considered a potential contraindication to thrombolysis. Evidence regarding the safety of thrombolysis administration in patients with a previous history of ICH is scarce. We encountered a patient with acute ischemic stroke with a past history of hypertensive ICH. A 59-year-old female, presented with complete right-sided body weakness, global aphasia and gaze preference. A computed tomography (CT) brain perfusion scan revealed a mismatch suggestive of left middle cerebral artery (MCA) ischemic stroke. The patient received intravenous thrombolysis and showed significant clinical improvement with no subsequent complications or ICH. In reporting this case, we aim to provide evidence supporting the safety of thrombolytic therapy in selected cases with a previous history of ICH when no alternative line of management is available.