Thrombolysis beyond the guidelines: two treatments in one subject within 90 hours based on a modified magnetic resonance imaging brain clock concept

• Published in: Stroke (1970) Vol. 36; no. 11; p. e162
• Main Authors: Topakian, Raffi, Gruber, Franz, Fellner, Franz A, Haring, Hans-Peter, Aichner, Franz T
• Format: Journal Article
• Language: English
• Published: United States 01-11-2005
• Subjects: Brain - pathology; Brain Ischemia - therapy; Humans; Male; Middle Aged; Middle Cerebral Artery - pathology; Recurrence; Stroke - therapy; Thrombolytic Therapy - methods; Time Factors
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000185799.22645.8a

We report the first case of 2 intravenous thrombolysis treatments within 90 hours in a patient with early recurrent stroke.
A 50-year-old man had improved significantly after intravenous thrombolysis for acute stroke. On the fourth day, he deteriorated dramatically because of recurrent stroke. Evidence of vessel reocclusion and profound perfusion/diffusion mismatch constituted the rationale for a second thrombolysis treatment, which resulted in vessel recanalization and significant neurologic improvement.
The pathophysiological information obtained by multimodal magnetic resonance imaging may suit as a brain clock when repeat thrombolysis treatment is considered for early recurrent stroke.