Improving stroke care in Indonesia: Integrating CT perfusion for enhanced prognostication and treatment guidance - A case report

Abstract

Background. Over the last three decades, stroke management has witnessed substantial progress, from the introduction of recombinant tissue plasminogen activator (rtPA) in 1995 to the approval of thrombectomy in 2016. Intravenous tissue plasminogen activator (tPA) within 4.5 hours of symptom onset is the standard for eligible acute ischemic stroke patients, dissolving clots and restoring blood flow. Endovascular thrombectomy (EVT) surpasses intravenous thrombolysis for large vessel occlusion cases, typically within 6 to 24 hours based on CT-perfusion criteria. CT perfusion (CTP) provides crucial quantitative data on cerebral blood flow, aiding in ischemia detection, tissue assessment, treatment guidance, and outcome prediction. This case report marks a pivotal moment in Indonesian stroke management, introducing the inaugural use of CTP for diagnostic purposes. By scrutinizing blood flow dynamics and cerebral conditions, CTP augments conventional diagnostics, offering enhanced prognostic value. Case presentation. The case of a 58-year-old male with notable comorbidities exemplifies this successful integration. He presented with sudden left-sided weakness and dysarthria, without accompanying symptoms. Neurological evaluation revealed a Glasgow Coma Scale score of E3M6V5, 7th cranial nerve paresis, and a positive Babinski reflex on the left side. With a National Institute of Health Stroke Scale (NIHSS) score of 10, a head CT scan rules out cerebral hemorrhage, prompting precise thrombolysis at 0.7 mg/kg. Within one hour post-thrombolysis, the NIHSS score improved to 6, ultimately culminating in an NIHSS score of 2 upon discharge. Conclusion. This case underscores the efficacy of acute ischemic stroke management, fortified by the strategic integration of CTP, heralding a new era in Indonesian stroke care.