title: [Successful local thrombolytic therapy for atherosclerotic middle cerebral artery occlusion 24 hours after onset: case report].
abstract: We describe success with local thrombolytic therapy given to a patient 24 hours after onset of left middle cerebral artery (MCA) occlusion. A 53-year-old man was admitted 18 hours after onset of disorientation, motor aphasia, and right upper and lower limb weakness. Computed tomography (CT) showed an area of slightly decreased density in the deep left frontal white matter. A stable Xenon CT cerebral blood flow study revealed mildly decreased perfusion in the left MCA territory, which showed negative cerebrovascular reactivity. FLAIR method magnetic resonance images demonstrated an area of slight hyperintensity in the left frontal white matter. Angiography showed atherothrombotic left MCA occlusion. 24 hours after clinical onset of occlusion, we successfully performed local thrombolytic therapy with urokinase. The patient's neurological status improved immediately. While indications for local thrombolysis in cerebral infarction presenting more than 6 hours after onset have not been established, we experienced success in the present patient who presented 18 hours after onset.
authors.affiliation: Department of Neurosurgery, Ogori Daiichi General Hospital, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Urakawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueda
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D002533:Cerebral Angiography; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015912:Thrombolytic Therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D014568:Urokinase-Type Plasminogen Activator