Effectiveness of Thrombolytic Therapy in Acute Embolic Stroke due to Infective Endocarditis.
Objective. To identify the role of thrombolytic therapy in acute embolic stroke due to infective endocarditis. Design. Case report. Setting. University hospital. Patient. A 70-year-old male presented with acute onset aphasia and hemiparesis due to infective endocarditis. His head computerized tomographic scan revealed left parietal sulcal effacement. He was given intravenous tissue plasminogen activator with significant resolution of the neurologic deficits without complications. Main Outcome Measures. Physical examination, National Institute of Health Stroke Scale, radiologic examination results. Conclusions. Thrombolytic therapy in selected cases of stroke due to infective endocarditis manifesting as major neurologic deficits can be considered as an option after careful consideration of risks and benefits. The basis for such favorable response rests in the presence of fibrin as a major constituent of the vegetation. The risk of precipitating hemorrhage with thrombolytic therapy especially with large infarcts and mycotic aneurysms should be weighed against the benefits of averting a major neurologic deficit.
Sontineni
Siva P
SP
Division of Cardiology, Creighton University, Omaha, NE 68131, USA.
Mooss
Aryan N
AN
Andukuri
Venkata G
VG
Schima
Susan Marie
SM
Esterbrooks
Dennis
D
Eur Heart J. 2004 Feb;25(3):267-76
14972429
Heart. 2006 Jan;92(1):124-30
16365367
Eur Heart J. 1990 Dec;11(12):1074-8
2292253
AJNR Am J Neuroradiol. 2007 Mar;28(3):513-7
17353326
Neurology. 2003 Nov 25;61(10):1341-6
14638952
Clin Infect Dis. 2007 May 1;44(9):1180-6
17407036
JAMA. 1999 Dec 1;282(21):2003-11
10591382
Neurology. 2007 Jun 12;68(24):2132-9
17562835
Eur Neurol. 1990;30(2):87-9
2340840
Neurology. 2003 Nov 25;61(10):1324-5
14638946
Stroke. 1990 May;21(5):695-700
2187287
Cerebrovasc Dis. 2003;16(3):295-7
12865620
Dev Med Child Neurol. 2009 Feb;51(2):151-4
19191846
Stroke. 1987 Nov-Dec;18(6):1048-56
3686576
AJNR Am J Neuroradiol. 1999 Aug;20(7):1291-9
10472989
Cardiovasc Pathol. 2006 Sep-Oct;15(5):256-263
16979032
N Engl J Med. 1995 Dec 14;333(24):1581-7
7477192
Stroke. 1992 Jun;23(6):843-50
1595103