Successful stroke thrombolysis beyond guidelines: A case series

Azliza Ibrahim and Mohd Fandi Al Khafiz and Anna Misyail and Alvin Oliver Payus and Yap, Moon Yan and Abdul Hanif Khan and Loh, Wei Chao and Janudin and Maz Anirah and Liyana Najwa and Wan Aliaa and Hoo, Fan Kee and Hamidon Basri (2022) Successful stroke thrombolysis beyond guidelines: A case series. Romanian Journal of Neurology, 21. pp. 90-94. ISSN 1843-8148 (P-ISSN) , 2069-6094 (E-ISSN)

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Abstract

Intravenous (IV) thrombolysis is a safe and effective treatment for acute ischemic stroke. The therapeutic benefit is not extended to more than 4.5 hours in many patients due to the protocol’s time window restriction. Here, we reported two acute stroke cases with a moderate National Institutes of Health Stroke Scale (NIHSS) and onset greater than 4.5 hours that were successfully thrombolysed with intravenous recombinant tissue plasminogen activator (tPA) - low-dose Tenecteplase (TNK). The decision to thrombolysed both patients were based on Magnetic Resonance Imaging (MRI) Diffusion-weighted imaging (DWI)-Fluid Attenuation Inversion Recovery (FLAIR) mismatch – tissue basis rather than a time window, and this resulted in a good neurological recovery with a significant improvement in functional Modified Rankin Score (MRS) to zero at 90 days post stroke regardless of the stroke aetiology. In summary, Intravenous thrombolysis in acute ischemic stroke outside the therapeutic window but with significant penumbra based on MRI DWI-FLAIR tissue mismatch resulted in a remarkable neurological recovery after 90 days.

Item Type:	Article
Keyword:	Stroke , Thrombolysis , Tissue window , Tenecteplase
Subjects:	R Medicine > RC Internal medicine > RC31-1245 Internal medicine > RC321-571 Neurosciences. Biological psychiatry. Neuropsychiatry > RC346-429 Neurology. Diseases of the nervous system Including speech disorders
Department:	FACULTY > Faculty of Medicine and Health Sciences
Depositing User:	SAFRUDIN BIN DARUN -
Date Deposited:	15 Aug 2022 12:18
Last Modified:	15 Aug 2022 12:18
URI:	https://eprints.ums.edu.my/id/eprint/33761

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