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When Not To Thrombolyse - A Case Series
- 1. Hyperacute Stroke: When Not To Thrombolyse Dr Saumya H Mittal Neurologist. Dr Mittal’s Mediclinic, Noida. Sharda Hospital and Medical College, Greater Noida. Felix Hospital, Noida. Yatharth Superspeciality Hospital, Greater Noida
- 2. Case 1 • 68 years. • Female. • Euglycemic. • Normotensive. • Euthyroid. • No surgical history. • Presented with- – Slurred speech. – Difficulty in swallowing. – Hemiparesis: Power 4+/5. – Left Plantar Mute. – In EMR. – Taken up for MRI. TIME OF PRESENTATION- 1.5 HOURS.
- 3. MRI showed few lacunar left basal ganglia infarcts.
- 4. MRA and CV Doppler was normal. CBC, LFT, KFT , HbA1C and Lipid Profile were normal. CXR showed a coined lesion. HRCT Chest was done- suggested possible Bronchogenic Carcinoma.
- 5. • Thrombolysis was not done- NIHSS = 3. • She improved with speech therapy and physiotherapy and was discharged. • Evaluation of Bronchogenic Carcinoma continues with Oncology Unit.
- 6. Case 2 • 78 Years. • Gentleman. • Hypertensive.BP- 190/110 • Diabetic.RBS-438 mg/dl. • Euthyroid. • Alcohol User. • Smoker. • Presented with- – Altered Sensorium. – Had a seizure on the way to hospital. – Hemiparesis: Power 1/5. – Plantar Mute. – In EMR. – Taken up for MRI. TIME OF PRESENTATION- 1/2 HOUR.
- 10. • He was taken up for craniectomy. Speech therapy and physiotherapy was offered with conservative management. • Thrombolysis was not done- – Family was unwilling in view of side effects. – NIHSS = 33. – Malignant MCA Infarct. – Large vessel occlusion.
- 11. Case 3 • 66 Years. • Gentleman. • Hypertensive. • Euglycemic. • Euthyroid. • Alcohol User. • Presented with- – Inability to Speak. – No headache. – No hemiparesis. – No hemisensory loss. – No ataxia. TIME OF PRESENTATION- 1 HOUR.
- 15. • Thrombolysis was not done- SDH. • He was managed by neurosurgery unit and improved after surgery and with speech therapy and physiotherapy. • Was discharged.
- 16. Case 4 • 28 years. • Female. • Euglycemic. • Normotensive. • Euthyroid. • No surgical history. • On Day 1 of Menses. • Presented with- – Facial Palsy. – Slurred speech. – Difficulty in swallowing. – Hemiparesis: Power 4+/5. – Plantar Mute. – Symptoms improving. – In EMR. – Taken up for MRI. TIME OF PRESENTATION- 2 HOUR.
- 19. • MRA was normal. • CV Doppler was normal. • Lipid Profile was normal. • HbA1C was normal. • CBC, LFT, KFT was normal. • Thrombolysis was not done- – Active Menses. – Improving Symptoms ? TIA.
- 20. POINT TO LEARN While thrombolysis and thrombectomy are options of treatment in stroke, one needs to know when it should not be done. A proper checklist of Indications and Contraindications should be consulted and checked before performing thrombolysis.