title: Thrombolytic therapy at systemic lupus onset with secondary antiphospholipid syndrome. A rare stroke experience.
abstract: Strokes are a major cause of disability in systemic lupus erythematosus (SLE). Classical neurological manifestations are rare at onset. The use of thrombolytic therapy improves clinical outcome in eligible stroke patients who present early. Modern imaging modalities augment decision making. This 37-year-old woman presented with an acute stroke with National Institute of Health stroke scale 10. The CT showed a hyperdense middle cerebral artery (MCA) dot sign. The magnetic resonance angiography revealed focal thromboembolic occlusion at the insular MCA segment (M2). Intravenous recombinant tissue plasminogen activator (rtPA) was administered with successful recanalization. The present case was a rare event for rtPA use in acute MCA occlusion with underlying latent lupus. Acute vascular event thrombolysis as the presenting manifestation of autoimmune disease has not previously been encountered on literature review. Stroke pathophysiology in conditions of hypercoagulability is a significant clinical entity where the implication for thrombolytic use requires further studies. An ischemic stroke with underlying connective tissue disease benefits from timely multimodal brain imaging and should be considered for reperfusion.
authors: Department of Internal Medicine, Imam Abdulrahman Binfaisal Hospital, National Guard Health Affairs, PO Box 4616, Dammam 31412, Kingdom of Saudi Arabia. E-mail: lohariaj@ngha.med.sa / jjloharia@yahoo.com.
authors: Juned J
authors: JJ
authors: Loharia
authors: Junaid M
authors: JM
authors: Alam
authors: Hassan A
authors: HA
authors: Abdelhadi
authors: Tamer F
authors: TF
authors: Marei
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000188:drug therapy* / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D018810:Magnetic Resonance Angiography; D020768:Middle Cerebral Artery / Q000473:pathology; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
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