2010年1月2日 星期六

Is rt-PA indicated?

Suppose you meet with this patient, what will you do?

This 43-year-old lady has hypertension and DM about 5-6 years without medical treatment. This time, she came to our ER because she felt dizzy and facial flushing. Initially at ER, high blood pressure( 270/134mmHg) was found. Besides, hypokalemia(K= 3.3 meq/L) and hyperglycermia(325mg/dl) were also noted. There was no headache, blurred vision, or neurological focal sign. She was treated as hypertensive crisis. After NTG injection, she was transferred to ICU at 17:55. Unfortunately, left limbs weakness and slurred speech occurred about 18:20 PM. At that time, blood pressure was lowered to 95/60 mmHg. NTG was stopped immediately. Left hemiparesis, hypothesia, dysarthria, dysphagia, left central type facial and dizziness persisted. Neurologist was called to see this lady at 19:00. Head CT was normal and NIHSS score was 7. Her brother hesitated thrombolytic therapy for fear of the risk of intracranial bleeding. Emergent brain MRI was therefore done at 20:00, and it revealed acute infarction on right pons and no stenosis of basilar artery. According to her clinical presentation and neuroimaging findings, will you prescribe rt-PA to treat her stroke?

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