INTRAVENOUS THROMBOLYSIS IN A PATIENT WITH A CALCIFIED CEREBRAL EMBOLUS: A CASE REPORT

Bajram Kamberi

Abstract

Background: Recent clinical reports have been reported with information on the calcified cerebral embolus as a cause of acute ischemic stroke (AIS). Middle cerebral artery is considered as the most common site of calcified embolism. In the management of AIS, thrombolysis with intravenous tissue plasminogen activator (rt-PA) is still the preferred treatment. Results of rt-PA administration remain limited. The aim of this case report is to describe background, treatment and outcome of a 74-year-old female patient with acute onset of right central facial paralysis, moderate dysarthria, right hemiplegia, and a positive Babinski sign that started one hour prior to admission in the Department of Neurology in Clinical Hospital Tetovo. The patient`s NIHSS (National Institutes of Health Stroke Scale) score was 23, and her MRS (Modified Rankin Score) was level 4. Initial non-contrast computer tomography of the head did not show for bleeding, no acute ischemic changes, but revealed a focus of calcification (maximum value of 320 HU). Patient after tissue plasminogen activator treatment showed symptomatic improvement (NIHSS score 12, MRS 3). Three months later, the patient`s NIHSS score was 5, and her MRS was 2. She could manage all activities of daily living with assistance. Conclusion: In this case, AIS can be attributed to the embolism resulting from the fragmentation of an already existing calcified embolus. This non-fresh blood clot may be one cause for the result of rt-PA administration in this case. The patient responded well to treatment, despite the additional interventions can be used in the future to aid in great improvements.

Pages: 32 - 37