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Images in Neurology
March 2009

Would You Perform Thrombolysis in This Acute Ischemic Stroke Patient?

Arch Neurol. 2009;66(3):410-411. doi:10.1001/archneurol.2008.594

A 70-year-old man presented to our hospital within 90 minutes of a sudden onset of right-sided weakness and an inability to speak. He did not have a fit, fall, or injury preceding or following the symptoms. His medical history included diabetes mellitus, hypertension, and hypercholesterolemia. Results of his clinical examination at 100 minutes after symptom onset were remarkable: he had a blood pressure of 206/110 mm Hg, global aphasia, left-gaze deviation, and right-sided hemiplegia (National Institutes of Health Stroke Scale score, 13). Emergent noncontrast computed tomography (CT) of the brain performed at 112 minutes is shown in the Figure. Results from laboratory investigations (hemoglobin, full blood cell counts, prothrombin and partial thromboplastin times, and kidney and liver function tests) were within normal limits and his blood glucose concentration was 203.6 mg/dL (to convert to millimoles per liter, multiply by 0.0555). With the given details, should he have been treated with intravenous thrombolysis?

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