Abstract
Objective: To report the treatment of ischemic stroke in a pregnant woman with intravenous recombinant tissue plasminogen activator (IV rtPA). Background Although cerebrovascular complications of pregnancy are well recognized, the data on IV rtPA in acute ischemic stroke of pregnant women is exceedingly scarce. Design/Methods: Single case study. Results: A 35-year old woman in her 27 th week of pregnancy presented one hour after the onset of global aphasia and mild right-sided brachiofacial hemiparesis (NIHSS 7). Cerebrovascular risk factors included hypercholesterolemia, a history of smoking and migraine, and a persistent foramen ovale. Immediate cerebral magnetic resonance (MR) imaging of a stroke protocol showed a faint diffusion weighted MR hyperintensity in the anterior territory of the left middle cerebral artery with normal appearance in FLAIR. Color-coded duplex sonography directly visualized a high-grade stenosis of a branch of the left MCA and documented a greater than 30% reduction of flow velocity in M1 as compared to the right MCA. MR angiography supported this diagnosis of left M2/M3 stenosis. After informed consent from the husband, the patient received IV rtPA at a dose of 0.9 mg/kg body weight over 1 hour, starting 1,75 h after onset of symptoms. The patient fully recovered within 1 hour after the end of IV rtPA administration. Anticoagulation was started after 24 h with subcutaneous low molecular weight heparin for the rest of the pregnancy. At term, the delivery of a healthy baby (2700g, 47 cm, Apgar Index 9-10-10) occured. Conclusions: The use of rtPA in pregnant women is neither particularly tested nor recommended, however, it is known not to cause fetotoxicity or teratogenicity and does not cross the placenta. IV rtPA may be considered in severe ischemic stroke in pregnant women, especially when alternative therapies are lacking. Disclosure: Dr. Wohrle has nothing to disclose. Dr. Tveici has nothing to disclose. Dr. Werner has nothing to disclose.
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