title: Successful Systemic Thrombolysis in an Adolescent With Acute Ischemic Stroke.
abstract: BACKGROUND
  Current treatment guidelines for acute ischemic stroke do not recommend thrombolytic therapy in children and adolescents as data are still very scarce.
  
  
  METHODS
  We report the case of a 15-year-old boy who suddenly developed severe left-sided weakness and speech difficulty while stooling. Upon arrival at our Emergency Department, the National Institute of Health Stroke Scale (NIHSS) score was 18. Urgent neurovascular ultrasound showed a distal occlusion of the right internal carotid artery and occlusion at the origin of the middle cerebral artery (MCA) and the anterior cerebral artery. He was treated 2 hours after symptom onset with intravenous recombinant tissue plasminogen activator without any complication. At the end of thrombolysis, a complete recanalization was shown by transcranial Doppler sonography, although a brain magnetic resonance imaging disclosed an acute right middle cerebral artery stroke. At discharge, the boy had mild weakness on his left leg and slight left facial palsy: the NIHSS score was 2. To our knowledge, this is the first intravenous thrombolytic treatment ever reported in an adolescent in Italy.
  
  
  CONCLUSIONS
  Despite the lack of evidence regarding the safety and the efficacy of recombinant tissue plasminogen activator in pediatric stroke, this treatment option should be considered, especially in adolescents presenting within 3 hours from symptom onset in centers with consolidated experience in adult thrombolysis.
authors.affiliation: Departments of *Neurological Sciences †Neuroradiology ‡Emergency Medicine §Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua School of Medicine, Padua, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Viaro
authors.forename: Renzo
authors.initials: R
authors.lastname: Manara
authors.forename: Filippo
authors.initials: F
authors.lastname: Farina
authors.forename: Anna
authors.initials: A
authors.lastname: Palmieri
authors.forename: Foscarina D
authors.initials: FD
authors.lastname: Rocca
authors.forename: Enzo
authors.initials: E
authors.lastname: Ballotta
authors.forename: Claudio
authors.initials: C
authors.lastname: Baracchini
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D002545:Brain Ischemia / Q000517:prevention & control*; D002341:Carotid Artery Thrombosis / Q000517:prevention & control*; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000517:prevention & control*; D020244:Infarction, Middle Cerebral Artery / Q000517:prevention & control*; D008297:Male; D011994:Recombinant Proteins; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator