A case of acute ischemic stroke: optimizing management with penumbra and vessel imaging.
BACKGROUND
An 83-year-old woman with a history of hypertension and dyslipidemia developed acute onset of impaired speech and comprehension, and right-sided weakness. Her previous medical history was notable for hyperthyroidism and a curative remote mastectomy for breast cancer. The patient was on two antihypertensive medications and a statin, and she was not receiving any antiplatelet medication. She was taken by ambulance to a primary stroke center. Initial examination showed global aphasia, right homonymous hemianopia, right hemiplegia, and hemisensory loss.


METHODS
Physical examination, laboratory tests, noncontrast head CT scan, multimodal brain MRI scan, catheter cerebral angiogram, echocardiogram, continuous cardiac monitoring.


METHODS
Acute ischemic stroke caused by distal left internal carotid artery occlusion, with salvageable penumbral tissue and a persistent large-vessel occlusion.


RESULTS
Neuroprotective study agent (total dose of 20 g intravenous MgSO(4) or matched placebo), intravenous tissue plasminogen activator, rescue mechanical thrombectomy using the Merci clot retrieval device.
Sunnybrook Health Sciences Centre, Toronto, ON, Canada. brianhbuck@gmail.com
Brian H
BH
Buck
Jeffrey L
JL
Saver
D000208:Acute Disease; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D019468:Disease Management; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D018696:Neuroprotective Agents / Q000627:therapeutic use; D020521:Stroke / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017131:Thrombectomy / Q000379:methods
D018696:Neuroprotective Agents