Management of Acute Ischemic Stroke in a Patient with a Past History of Intracranial Hemorrhage

Ghadeer Al-Shabeeb,Fatimah Al Zawad,Osama Basheir

doi:10.4236/nm.2020.111004

Ghadeer Al-Shabeeb, Fatimah Al Zawad + Show 1 more

Open Access

https://doi.org/10.4236/nm.2020.111004

Copy DOI

Abstract

Intravenous thrombolysis remains the gold standard in the management of acute ischemic stroke if the patient presents within the window period. Endovascular thrombectomy is another line of therapy in selected cases. Nonetheless, one of the most devastating complications of IV thrombolysis is intracranial hemorrhage (ICH); in such cases, the previous history of ICH is considered a potential contraindication to thrombolysis. Evidence regarding the safety of thrombolysis administration in patients with a previous history of ICH is scarce. We encountered a patient with acute ischemic stroke with a past history of hypertensive ICH. A 59-year-old female, presented with complete right-sided body weakness, global aphasia and gaze preference. A computed tomography (CT) brain perfusion scan revealed a mismatch suggestive of left middle cerebral artery (MCA) ischemic stroke. The patient received intravenous thrombolysis and showed significant clinical improvement with no subsequent complications or ICH. In reporting this case, we aim to provide evidence supporting the safety of thrombolytic therapy in selected cases with a previous history of ICH when no alternative line of management is available.

Highlights

We aim to provide clinical data that supports the safety of intravenous thrombolysis in selected cases of patients with a past history of intracranial hemorrhage, who present later with acute ischemic stroke, and who are deemed unfit for thrombectomy
The rate of intracranial hemorrhage (ICH) may be affected by the time of administering thrombolytic therapy, its type and dose, the computed tomography (CT) findings of hypodensity, and the current use of anticoagulant or anti-platelets agents [9]
Multiple studies have investigated the safety of IV thrombolysis in patients with a past history of ICH, data addressing the proper time interval between the ICH and AIS is lacking

Summary

Introduction

Despite the recent labeling of a history of intracranial hemorrhage (ICH) as a potential contraindication of intravenous thrombolysis in acute ischemic stroke. We report a rare case that involved a new practice of managing a patient with a prior history of intracranial hemorrhage who presented with acute ischemic stroke. From this case, we aim to provide clinical data that supports the safety of intravenous thrombolysis in selected cases of patients with a past history of intracranial hemorrhage, who present later with acute ischemic stroke, and who are deemed unfit for thrombectomy.

Objectives

Results

Discussion

Conclusion