一个有趣的急性中风案例:很多事情都出错了,但病人终于笑了!

D. Chakraborty, Nirmalya Ray, S. Dey, Sanjay Bhaumik
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摘要

一位患有肥厚性梗阻性心肌病、心房扑动和老右半脑卒中的52岁女性接受了植入式心律转复除颤器植入术治疗完全性心脏传导阻滞。她尚未开始常规抗凝治疗,并因急性右大脑中动脉(MCA)区域中风(NIH卒中量表/评分为14分)而被送往医院急诊。排除绝对禁忌症后,给予静脉溶栓治疗(血管内治疗没有血管靶点)。溶栓后,她有从颈内动脉到MCA的血块动员,并全身栓塞到肾脏和下肢。患者接受了紧急栓塞切除术,下肢免于截肢。我们的病例强调了在急性脑卒中患者溶栓后检查外周脉搏的重要性。虽然溶栓后患者病情开始恶化,但逐渐好转,并达到满意的修正Rankin量表,这凸显了溶栓治疗急性脑卒中的最终潜在益处。心房扑动患者在近期接受心脏手术后有很高的血栓形成的机会,特别是如果他们停用抗凝即使是很短的时间。因此,在适当的情况下不必要地担心抗凝剂的使用可能会造成危及生命的并发症。
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An Interesting Case of Acute Stroke: When Many Things Went Wrong, but the Patient Laughed at Last!
A 52-year-old lady with hypertrophic obstructive cardiomyopathy, atrial flutter, and old right hemispheric stroke in the background underwent implantable cardioverter-defibrillator implantation for complete heart block. She was yet to start her regular anticoagulant and presented to hospital emergency with acute right middle cerebral artery (MCA) territory stroke (NIH Stroke Scale/Score of 14). After ruling out absolute contraindications, she was given intravenous thrombolysis (did not have a blood vessel target for endovascular therapy). Post thrombolysis, she had clot mobilization from the internal carotid artery to the MCA and systemic embolization to kidneys and lower limbs. The patient underwent an urgent embolectomy and lower limbs were saved from amputation. Our case highlights the importance of checking peripheral pulses in acute stroke patients post thrombolysis. Though the patient had initial deterioration after thrombolysis, she gradually improved and later achieved satisfactory modified Rankin scale underscoring the ultimate potential benefits of thrombolysis in acute stroke. There is a high chance of thrombus formation in patients with atrial flutter who undergo recent cardiac procedure especially if they are off anticoagulation for even a short period. Hence, unnecessary apprehension of anticoagulant use in proper situations may create life-threatening complications.
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