Assuntos
Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Hipotermia Induzida , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Feminino , Humanos , Hipotermia Induzida/métodos , Pessoa de Meia-IdadeRESUMO
BACKGROUND AND PURPOSE: Up to 15-25% of patients with ischemic stroke wake up with their deficits. Because of the uncertainty about the time of onset, these patients are generally not offered thrombolytic therapy. Some of these wake-up stroke patients may be eligible for acute endovascular stroke therapy based on hyperacute CT or MR imaging independent of the time window. REPORT: We report two patients with acute ischemic stroke whose symptoms were present upon awakening and who were successfully treated with endovascular interventions. RESULTS: The first patient was discharged with complete neurological recovery on second day after endovascular intervention. The second patient went home on fifth day with a mild left facial paresis and left arm drift. Both these patients did not have any neurological deficit on 18-month follow up. CONCLUSIONS: Some patients who present with stroke on awakening may be candidates for thrombolytic therapy or recanalization techniques irrespective of mode of therapy (intravenous, intravenous+intra-arterial or intra-arterial tPA alone). Further randomized, controlled studies are warranted to safely identify those candidates who would benefit from thrombolysis and endovascular interventions in ischemic wake-up strokes.
Assuntos
Isquemia Encefálica/terapia , Procedimentos Endovasculares/métodos , Reperfusão/métodos , Acidente Vascular Cerebral/terapia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Angioplastia com Balão , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/patologia , Embolectomia , Feminino , Humanos , Masculino , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/patologiaRESUMO
BACKGROUND AND PURPOSE: Reocclusion of intracranial arteries after successful recanalization is associated with poor clinical outcome. The role of Factor V Leiden mutation in intracranial arterial thrombosis/rethrombosis is unclear. SUMMARY OF REPORT: We report the case of a patient who developed recurrent reocclusions of the middle cerebral artery after intra-arterial thrombolysis for acute ischemic stroke. The patient subsequently underwent transcatheter clot retrieval followed by successful stent-supported angioplasty of the occluded segment. He underwent a detailed workup for thrombophilia. The patient was detected to be heterozygous for Factor V Leiden mutation without any other cause for thrombophilia. CONCLUSIONS: Factor V Leiden mutation could be a contributing etiology for reocclusion after endovascular interventions in stroke. Systematic studies looking for thrombophilic mutations in patients with arterial reocclusion might be warranted.
