Life-Threatening Anaphylactoid Reaction in an Acute Ischemic Stroke Patient With Intravenous rt-PA Thrombolysis, Followed by Successful Intra-Arterial Thrombolysis

An anaphylactoid reaction to recombinant tissue plasminogen activator (rt-PA) is an uncommon but fatal complication. A 39-year-old man was admitted within 1 hour of the onset of a right hemispheric stroke. He was not taking any specific medication, including angiotensin-converting enzyme (ACE) inhibitors. A systemic anaphylactoid reaction developed immediately after rt-PA infusion. However, the symptoms were improved after treatment with a steroid and antihistamine. Subsequent intra-arterial thrombolytic therapy resulted in complete recanalization and clinical improvement. To our knowledge, this is the first report of a life-threatening anaphylactoid reaction after rt-PA treatment followed by successful intra-arterial thrombolytic therapy in a patient who had not taken an ACE inhibitor.

Japanese-B Virus Encephalitis With Biphasic Illness Pattern

Japanese-B virus encephalitis (JE), the most common human endemic and epidemic encephalitis, usually has a uniphasic illness with a variable outcome. A 49-year-old woman with cognitive dysfunction from JE had improved over 3 weeks. Brain MRI revealed multiple lesions in the bilateral thalamus, caudate nuclei and medial temporal lobe. Two weeks after discharge, the patient showed re-aggravation of the cognitive dysfunction and lapsed into coma. We report a patient with JE having showed biphasic illness pattern.

A Patient of Thyroid Storm with Neurological Manifestations and MRI Abnormalities

Thyrotoxicosis autoimmune encephalopathy (TAE) and Hashimoto's encephalopathy (HE) are steroid responsive disorders of persistent or relapsing neurological or neuropsychological deficits associated with elevated serum concentrations of an antithyroid antibody. Most patients with TAE or HE are reported to have normal brain imaging findings at the time of presentation. We report here a rare case of TAE in whom brain MRI abnormalities were associated with clinical manifestations of thyroid storm.