title: [Pulseless arrest in an elderly patient treated with intravenous tissue plasminogen activator for cardioembolic ischemic stroke].
abstract: A 77-year-old woman, who had a history of rheumatic mitral stenosis with atrial fibrillation (AF), was referred and admitted to our hospital because of a transient ischemic attack at 4: 55 p.m.. She had taken warfarin for over 10 years, but her condition was not well controlled on admission. At 8: 30 p.m., she had acute ischemic stroke with right facial palsy, right hemiparesis and slurred speech. At 10: 35 p.m., she was treated with intravenous tissue plasminogen activator (t-PA) and her neurological deficits almost fully recovered by 0: 05 a.m. (90 min after t-PA started). At 0: 08 a.m., she collapsed due to sudden pulseless arrest. Using advanced life support, she soon recovered with no complications. After mitral valve replacement and left atrial appendectomy, she was discharged with a modified Rankin scale 0 at day 40. To the best of our knowledge, this is the first case report showing pulseless arrest immediately after treatment with t-PA in an elderly patient with ischemic stroke. Left insular injury seemed to be a crucial mechanism of pulseless arrest in this case.
authors.affiliation: Department of Cardiology, Ehime Prefectural Central Hospital.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kawada
authors.forename: Kenji
authors.initials: K
authors.lastname: Kamogawa
authors.forename: Kensho
authors.initials: K
authors.lastname: Okamoto
authors.forename: Bungo
authors.initials: B
authors.lastname: Okuda
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000188:drug therapy*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D007275:Injections, Intravenous; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D010959:Tissue Plasminogen Activator