title: Hemiplegia and thrombolysis.
abstract: OBJECTIVE
  Hemiplegia at stroke onset may be considered a contraindication for thrombolytic therapy. We describe the outcome of patients with ischaemic stroke presenting with hemiplegia and treated with intravenous alteplase (tPA).
  
  
  METHODS
  All patients treated with tPA for acute ischaemic stroke between 1995 and 2010 were prospectively recorded in the Helsinki Stroke Thrombolysis Registry. Patients with basilar artery occlusion (BAO) were excluded. Hemiplegia was defined as no visible voluntary movement on ipsilateral arm and leg.
  
  
  RESULTS
  Of all treated patients (n = 1579), we excluded those with BAO (n = 152). Of remaining 1427 patients, 81 (6%) had hemiplegia at baseline. By 24 h, three had died and 20 retained their total hemiplegia. At day 7, a further nine had died, and 10 had persistent hemiplegia. A good 3-month outcome, modified Rankin Scale (mRS, 0-2), was observed in 23%, independence in ambulatory function (mRS 3) in further 16%, while 9% were bedridden and 20% dead. A wide clinical spectrum of neurological deficits coexisted with hemiplegia. With advanced age, more neurological functions lost, and with early radiological signs, the prognosis of patients with hemiplegia deteriorated. With combined fixed eye deviation (n = 23), half were either bedridden (n = 3) or dead (n = 9) by 3 months, and fatal intracerebral haemorrhage were common (n = 5).
  
  
  CONCLUSIONS
  Hemiplegia at presentation should not prevent thrombolytic therapy by itself, as limb movements are likely to return, and two of five thrombolysis-treated patients will walk independently by 3 months. With combined fixed eye deviation, the outcome is poorer and haemorrhagic complications are common.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. atte.meretoja@fimnet.fi
authors.forename: A
authors.initials: A
authors.lastname: Meretoja
authors.forename: D
authors.initials: D
authors.lastname: Strbian
authors.forename: J
authors.initials: J
authors.lastname: Putaala
authors.forename: M
authors.initials: M
authors.lastname: Kaste
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006429:Hemiplegia / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator