重组组织型纤溶酶原激活剂在急性脑卒中合并结节性硬化患者中的应用

Reza Bavarsad Sahripour, A. Maleki, B. Krishnaiah, A. Alexandrov
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引用次数: 0

摘要

结节性硬化症(TS)是一种常染色体显性遗传病,已知已有一个多世纪,并以累及任何器官的特征性错构瘤病变为特征。在本报告中,我们报告了一位急性栓塞性卒中患者,接受了组织纤溶酶原激活剂(tPA)和机械取栓(MT)。她的反应很明显,没有任何出血性并发症。患者为68岁白人女性,自幼有TS病史,以左大脑中动脉(MCA)综合征(右侧无力、感觉丧失、右侧面部下垂、失语、偏盲、构音障碍)就诊。美国国立卫生研究院卒中量表(NIHSS)得分为19分。除皮质结节、室管膜下脑室钙化外,头部CT未见任何急性异常。头部及颈部CT血管造影显示左侧颈内动脉近端闭塞。排除所有排除标准后,患者接受tPA治疗并行完全再灌注MT(脑梗死溶栓(TICI) 3)。脑磁共振成像(MRI)显示多血管区域(双侧顶叶、左侧慢状核、左侧颞叶内侧、左侧丘脑和右侧枕叶)急性卒中提示栓塞现象,未见出血并发症。无论是血管畸形还是室管膜下巨细胞星形细胞瘤出血,TS患者发生脑出血的风险都会增加。后者的最佳解释可能是继发于颅内压升高引起的静脉压升高。幸运的是,我们的急性缺血性卒中的TS患者在窗口内,接受了tPA和MT治疗。患者不仅没有出现任何出血性副作用,而且神经系统症状也有了明显改善。据我们所知,这是唯一一例tPA应用于TS患者的病例报告。此外,我们需要更多的病例报告来评估tPA在这些患者中的安全性。中华神经科学杂志,2020;10(4):140-143 doi: https://doi.org/10.14740/jnr595
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Recombinant Tissue Plasminogen Activator Use in an Acute Stroke Patient With Tuberous Sclerosis
Tuberous sclerosis (TS) is an autosomal dominant disease known for over a century and recognized by characteristic hamartomatous lesions involving any organ. In this report, we are presenting a patient with TS who presented with acute embolic stroke and received tissue plasminogen activator (tPA) and had a mechanical thrombectomy (MT). She had a dramatic response without any hemorrhagic complications. She is a 68-year-old Caucasian woman with the past medical history of TS since childhood who presented to the hospital with symptoms of left middle cerebral artery (MCA) syndrome (right-sided weakness, sensory loss, right facial droop, aphasia, hemianopia, and dysarthria). National Institute of Health Stroke Scale (NIHSS) score was 19. Head computed tomography (CT) was negative for any acute abnormality except cortical tubers, subependymal ventricular calcification. CT angiography of the head and neck showed proximal occlusion of the left internal carotid artery. After ruling out all exclusion criteria, the patient received tPA and had an MT with complete reperfusion (thrombolysis in cerebral infarction (TICI) 3). Brain magnetic resonance imaging (MRI) showed an acute stroke in the multivessel territories (bilateral parietal cortices, the left lentiform nucleus, medial left temporal lobe, left thalamus, and right occipital lobe) suggestive of an embolic phenomenon and did not show any hemorrhagic complication. TS patients are at increased risk of intracerebral hemorrhage either in the setting of vascular malformation or due to hemorrhage into the subependymal giant cell astrocytoma. The best explanation for the latter could be secondary to elevated venous pressure from increased intracranial pressure. Fortunately, our TS patient who presented with acute ischemic stroke was within the window and received tPA and MT. The patient not only did not have any hemorrhagic side effects afterward but also had a significant improvement in her neurologic symptoms. To our best knowledge, this is the only case report of tPA administration in a TS patient. Moreover, we need more case reports to evaluate the safety of tPA in these patients. J Neurol Res. 2020;10(4):140-143 doi: https://doi.org/10.14740/jnr595
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