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Thrombolysis in a stroke patient with Marfan syndrome.

Chembala J, Natarajan I, Roffe C - JRSM Short Rep (2012)

View Article: PubMed Central - PubMed

Affiliation: Department of Stroke Medicine , Queens Hospital, Burton On Trent, Staffordshire, DE13 0RB , UK.

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In this patient with Marfan's syndrome and ischaemic stroke thrombolysis was associated with good outcome in spite of haemorrhagic transformation... Routine blood tests, electrocardiogram and chest X-ray were normal... A computed tomogram (CT) of the head, performed 2 h after symptom onset, did not show evidence of infarction or haemorrhage (Figure 1)... There was also swelling of the ipsilateral left cerebral hemisphere with mild midline shift towards right... Over the next few days, the patient gradually improved with continued physiotherapy... He underwent further investigations to discover the aetiology of the stroke... Carotid Doppler did not show any evidence of significant carotid stenosis... To our knowledge, this is the first report of a patient with Marfan syndrome treated with thrombolysis for acute ischaemic stroke... While it is important to report this finding, it would not be appropriate to withhold thrombolysis from patients with Marfan syndrome in future on the basis of our report... It is also important to rule out the possibility of aortic dissection in Marfan patients before thrombolysis... The patient we report here, developed a haemorrhagic complication after thrombolysis, which did not affect his recovery... More reports on thrombolysis outcome in Marfan patients are required to assess its safety in this patient group... None declared None Written informed consent was obtained from the patient or next of kin JC All authors contributed equally None

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CT head scan 20 hours post thrombolysis showing left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area
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SHORTS-12-001F2: CT head scan 20 hours post thrombolysis showing left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area

Mentions: On examination, he had a partial left anterior circulation syndrome with right hemiparesis (Medical Research Council grade power of 3/5 in the arm and 4/5 in the leg), a right upper motor neuron facial palsy, expressive dysphasia, and right sided visual neglect. His National Institute of Health Stroke Scale (NIHSS) score was 12. His blood pressure was low at 100/80 mm Hg. Apart from the thoracotomy scar, and the tall features of Marfan syndrome his physical examination was normal. Routine blood tests, electrocardiogram and chest X-ray were normal. A computed tomogram (CT) of the head, performed 2 h after symptom onset, did not show evidence of infarction or haemorrhage (Figure 1). Intravenous thrombolysis with alteplase at a dose of 0.9 mg/kg bodyweight was started 2 hours and 30 min after the onset of symptoms. There were no immediate complications, and he remained haemodynamically stable. Twenty hours later he became drowsy. His NIHSS score worsened to 18 with more pronounced right hemiparesis. A repeat CT head scan (Figure 2) showed an established left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area. There was also swelling of the ipsilateral left cerebral hemisphere with mild midline shift towards right. Over the next few days, the patient gradually improved with continued physiotherapy. At 9 days, he was able to transfer independently from bed to chair. His NIHSS score was 7 with word finding problems, partial right hemianopia, right visual neglect and a mild right hemiparesis. A Repeat CT head scan at 2 weeks showed an established infarct and complete resolution of haemorrhagic transformation (Figure 3). At this stage he was commenced on aspirin. He was discharged home after 3 weeks when he was mobilizing independently, though he had mild right upper limb weakness, dysphasia and cognitive impairment. At three months he was able to communicate and physically independent, but he was unable to return to his usual hobbies and work because his memory had deteriorated, he could not coordinate his right hand, and had word finding problems. He underwent further investigations to discover the aetiology of the stroke. Carotid Doppler did not show any evidence of significant carotid stenosis. ECHO cardiography showed a normal aortic root and a normally functioning prosthetic aortic valve though the ejection fraction was low at 41 %. There was no evidence of aortic dissection.


Thrombolysis in a stroke patient with Marfan syndrome.

Chembala J, Natarajan I, Roffe C - JRSM Short Rep (2012)

CT head scan 20 hours post thrombolysis showing left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3375845&req=5

SHORTS-12-001F2: CT head scan 20 hours post thrombolysis showing left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area
Mentions: On examination, he had a partial left anterior circulation syndrome with right hemiparesis (Medical Research Council grade power of 3/5 in the arm and 4/5 in the leg), a right upper motor neuron facial palsy, expressive dysphasia, and right sided visual neglect. His National Institute of Health Stroke Scale (NIHSS) score was 12. His blood pressure was low at 100/80 mm Hg. Apart from the thoracotomy scar, and the tall features of Marfan syndrome his physical examination was normal. Routine blood tests, electrocardiogram and chest X-ray were normal. A computed tomogram (CT) of the head, performed 2 h after symptom onset, did not show evidence of infarction or haemorrhage (Figure 1). Intravenous thrombolysis with alteplase at a dose of 0.9 mg/kg bodyweight was started 2 hours and 30 min after the onset of symptoms. There were no immediate complications, and he remained haemodynamically stable. Twenty hours later he became drowsy. His NIHSS score worsened to 18 with more pronounced right hemiparesis. A repeat CT head scan (Figure 2) showed an established left middle cerebral artery territory infarct with haemorrhagic transformation within the infarcted area. There was also swelling of the ipsilateral left cerebral hemisphere with mild midline shift towards right. Over the next few days, the patient gradually improved with continued physiotherapy. At 9 days, he was able to transfer independently from bed to chair. His NIHSS score was 7 with word finding problems, partial right hemianopia, right visual neglect and a mild right hemiparesis. A Repeat CT head scan at 2 weeks showed an established infarct and complete resolution of haemorrhagic transformation (Figure 3). At this stage he was commenced on aspirin. He was discharged home after 3 weeks when he was mobilizing independently, though he had mild right upper limb weakness, dysphasia and cognitive impairment. At three months he was able to communicate and physically independent, but he was unable to return to his usual hobbies and work because his memory had deteriorated, he could not coordinate his right hand, and had word finding problems. He underwent further investigations to discover the aetiology of the stroke. Carotid Doppler did not show any evidence of significant carotid stenosis. ECHO cardiography showed a normal aortic root and a normally functioning prosthetic aortic valve though the ejection fraction was low at 41 %. There was no evidence of aortic dissection.

View Article: PubMed Central - PubMed

Affiliation: Department of Stroke Medicine , Queens Hospital, Burton On Trent, Staffordshire, DE13 0RB , UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

In this patient with Marfan's syndrome and ischaemic stroke thrombolysis was associated with good outcome in spite of haemorrhagic transformation... Routine blood tests, electrocardiogram and chest X-ray were normal... A computed tomogram (CT) of the head, performed 2 h after symptom onset, did not show evidence of infarction or haemorrhage (Figure 1)... There was also swelling of the ipsilateral left cerebral hemisphere with mild midline shift towards right... Over the next few days, the patient gradually improved with continued physiotherapy... He underwent further investigations to discover the aetiology of the stroke... Carotid Doppler did not show any evidence of significant carotid stenosis... To our knowledge, this is the first report of a patient with Marfan syndrome treated with thrombolysis for acute ischaemic stroke... While it is important to report this finding, it would not be appropriate to withhold thrombolysis from patients with Marfan syndrome in future on the basis of our report... It is also important to rule out the possibility of aortic dissection in Marfan patients before thrombolysis... The patient we report here, developed a haemorrhagic complication after thrombolysis, which did not affect his recovery... More reports on thrombolysis outcome in Marfan patients are required to assess its safety in this patient group... None declared None Written informed consent was obtained from the patient or next of kin JC All authors contributed equally None

No MeSH data available.


Related in: MedlinePlus