Clinical and Radiological Difficulties to Detect Isolated MCA Dissection before Intravenous tPA Therapy

J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104365. doi: 10.1016/j.jstrokecerebrovasdis.2019.104365. Epub 2019 Sep 14.

Abstract

A 64-year-old woman was admitted to our hospital 48 minutes after sudden onset of dysphasia and right hemiplegia. Head computed tomography revealed small infarcts in the left putamen and 4-dimensional computed tomography angiography depicted high-degree stenosis in the left middle cerebral artery and delayed filling of the contrast media in the left middle cerebral artery territory. The patient underwent intravenous tissue plasminogen activator treatment. On day 5 of hospitalization, the patient underwent conventional cerebral angiography, revealing internal carotid artery to middle cerebral artery dissection. Fortunately, subarachnoid hemorrhage as an adverse effect did not occur, although iv-tPA was administered without detecting middle cerebral artery dissection.

Keywords: Intravenous recombinant tissue plasminogen activator—intracranial artery dissection—ischemic stroke—anterior circulation stroke.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Angiography, Digital Subtraction*
  • Carotid Artery, Internal, Dissection / diagnostic imaging*
  • Cerebral Angiography / methods*
  • Computed Tomography Angiography*
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Infarction, Middle Cerebral Artery / diagnostic imaging*
  • Infarction, Middle Cerebral Artery / drug therapy*
  • Middle Aged
  • Predictive Value of Tests
  • Risk Factors
  • Thrombolytic Therapy* / adverse effects
  • Tissue Plasminogen Activator / administration & dosage*
  • Tissue Plasminogen Activator / adverse effects
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator