Recurrent ischemic stroke post-thrombolysis in an older Ghanaian woman

Kwadwo F. Gyan, Priscilla A. Opare-Addo, Moses Siaw-Frimpong, Kwasi Ankomah, Fred S. Sarfo
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Abstract

Acute ischemic stroke management has evolved through several paradigms. Currently, thrombolysis is recommended for patients who present within 4.5 hours of acute ischemic stroke. Early neurological deterioration post-thrombolysis, however, may occur through several mechanisms. We report a case of a 66-year-old Ghanaian woman with multiple co-morbidities who presented with sudden onset right-sided weakness and aphasia of 2 hours duration. A diagnosis of acute ischemic stroke was made based on clinical examination and a computerised tomography scan of the brain. She underwent successful thrombolysis with recovery of full neurological function. She, however, developed a second ischemic stroke within 72 hours, with the likely aetiology being large vessel occlusion. This was subsequently managed conservatively. Extensive evaluation and control of specific stroke aetiologies is required for the prevention of stroke recurrence post thrombolysis. Also, the establishment of comprehensive stroke centres which provide neurovascular interventions in sub-Saharan Africa can help reduce stroke mortality and morbidity in eligible patients.
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一名加纳老年妇女溶栓后复发缺血性中风
急性缺血性卒中的治疗经历了多种模式的演变。目前,建议对急性缺血性卒中 4.5 小时内发病的患者进行溶栓治疗。然而,溶栓后早期神经功能恶化可能通过多种机制发生。我们报告了一例 66 岁的加纳女性患者,她患有多种并发症,在 2 小时内突然出现右侧肢体无力和失语。根据临床检查和脑部计算机断层扫描,诊断为急性缺血性脑卒中。她接受了成功的溶栓治疗,神经功能完全恢复。然而,她在 72 小时内又发生了第二次缺血性中风,病因可能是大血管闭塞。随后她接受了保守治疗。为预防溶栓后中风复发,需要对特定中风病因进行广泛评估和控制。此外,在撒哈拉以南非洲建立提供神经血管介入治疗的综合性中风中心有助于降低符合条件的患者的中风死亡率和发病率。
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