Neurological Surgery No Shinkei Geka Volume 39, Issue 3 (March 2011)

Middle Cerebral Artery Dissection Treated with Intravenous Tissue Plasminogen Activator Injection: A Case Report Ryokichi YAGI 1 , Akira SUGIE 1 , Hitoshi KOBATA 1 1Osaka Mishima Emergency Critical Care Center Keyword: dissection , infarction , rt-PA pp.275-279
Published Date 2011/3/10
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 We present a case of middle cerebral artery (MCA) dissection that was treated with intravenous administration of recombinant tissue plasminogen activator (rt-PA). A 72-year-old woman suddenly developed dysarthria and left motor weakness without headache. On arrival at the hospital,her NIH stroke scale (NIHSS) score was 13. Magnetic resonance imaging (MRI) revealed severe stenosis of the right proximal MCA segment; this appeared to be the cause of atherothrombosis. After the MRI study,her NIHSS score improved to 5,but the evidence of MCA stenosis indicated the need for thrombolytic treatment. We injected rt-PA 102 min after the symptom onset; however,her NIHSS score fluctuated thereafter; at worst,it was 13 at 78 min after the initiation of rt-PA treatment. Eventually,her neurological status improved and after 12 hours,her NIHSS score improved to 1 but the MRI showed cerebral infarction restricted in the right putamen. Since persistent irregularity of the right MCA was shown by follow-up magnetic resonance angiography (MRA),digital subtraction angiography was performed on the 14th day after admission. Double lumen of the right MCA was detected,which was a definite proof of artery dissection. Here,we discuss the difficulties encountered in the diagnosis and treatment for MCA dissection.

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Neurological Surgery 脳神経外科
39巻3号 (2011年3月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院