Use of intravenous tissue plasminogen activator in a 16-year-old patient with basilar occlusion.
Intravenous tissue plasminogen activator (t-PA) is currently approved by the US Food and Drug Administration (FDA) for the treatment of ischemic stroke in patients > 18 years of age who present within 3 hours of stroke onset and meet certain criteria. We report a case of a 16-year-old, previously healthy female who presented with a basilar artery occlusion and pontine ischemic stroke. She was treated with intravenous t-PA approximately 4 hours after the onset of symptoms. The patient demonstrated a remarkable recovery 6 hours after onset of her symptoms and had minimal deficits on discharge from the hospital 1 week later. She was found to have a lupus anticoagulant and was heterozygous for the prothrombin gene G2010A mutation. These were likely contributing causes for her stroke. She was also homozygous for plasminogen activator inhibitor 1 (PAI-1) 4G/4G, which at present is a controversial stroke risk factor.
Heil
Jason W
JW
University of Cincinnati, Department of Neurology, Cincinnati, Ohio 45267-0525, USA. heiljw@email.uc.edu.
Malinowski
Laurel
L
Rinderknecht
Andrea
A
Broderick
Joseph P
JP
Franz
David
D
D000293:Adolescent; D001488:Basilar Artery / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D025861:Blood Coagulation Disorders, Inherited / Q000150:complications* / Q000235:genetics* / Q000503:physiopathology; D020526:Brain Stem Infarctions / Q000188:drug therapy / Q000235:genetics / Q000503:physiopathology; D003424:Crohn Disease; D004252:DNA Mutational Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005820:Genetic Testing; D005838:Genotype; D006801:Humans; D016682:Lupus Coagulation Inhibitor / Q000097:blood / Q000235:genetics; D009154:Mutation / Q000235:genetics; D017395:Plasminogen Activator Inhibitor 1 / Q000235:genetics; D011516:Prothrombin / Q000235:genetics; D020127:Recovery of Function / Q000187:drug effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy* / Q000235:genetics* / Q000503:physiopathology
D005343:Fibrinolytic Agents; D016682:Lupus Coagulation Inhibitor; D017395:Plasminogen Activator Inhibitor 1; D011516:Prothrombin; D010959:Tissue Plasminogen Activator