Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2015
Pre-existing Mobile Cardiac Thrombus and the Risk of Early Recurrent Embolism after Intravenous Thrombolysis: A Case Report.
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Kobayashi Manami, Tanaka Ryota, Yamashiro Kazuo, Ueno Yuji, Kato Etsuro, Miura Seiji, Daida Hiroyuki, Hattori Nobutaka
Аннотация
BACKGROUND: Early recurrence of an embolism is rarely observed in patients with stroke treated with intravenous thrombolysis. Pre-existing cardiac thrombus is thought as a risk factor for recurrent embolism, although the relationship remains unclear.
METHODS: The present patient was a 30-year-old man with acute ischemic stroke. Transthoracic echocardiography performed before thrombolysis demonstrated an intraventricular mobile thrombus, and the patient was treated with intravenous thrombolysis 183 minutes after the onset of stroke. During thrombolysis, he suffered from a peripheral artery embolism, without further signs of neurologic deterioration. Repeated transthoracic echocardiography showed the disappearance of the intraventricular thrombus. However, follow-up magnetic resonance imaging disclosed new ischemic lesions at the splenium of the corpus callosum, and body computed tomography showed infarction of the spleen and kidney. The peripheral artery embolism improved spontaneously without further evidence of recurrent embolism.
RESULTS: This is the first report to provide findings of an intracardiac mobile thrombus before thrombolysis and to demonstrate the acceleration of detachment of the thrombus during thrombolysis.
CONCLUSIONS: Because there are currently no guidelines for the use of intravenous thrombolysis for acute ischemic stroke associated with a pre-existing intracardiac thrombus with respect to the efficacy and safety, physicians should pay special attention to similar cases.
METHODS: The present patient was a 30-year-old man with acute ischemic stroke. Transthoracic echocardiography performed before thrombolysis demonstrated an intraventricular mobile thrombus, and the patient was treated with intravenous thrombolysis 183 minutes after the onset of stroke. During thrombolysis, he suffered from a peripheral artery embolism, without further signs of neurologic deterioration. Repeated transthoracic echocardiography showed the disappearance of the intraventricular thrombus. However, follow-up magnetic resonance imaging disclosed new ischemic lesions at the splenium of the corpus callosum, and body computed tomography showed infarction of the spleen and kidney. The peripheral artery embolism improved spontaneously without further evidence of recurrent embolism.
RESULTS: This is the first report to provide findings of an intracardiac mobile thrombus before thrombolysis and to demonstrate the acceleration of detachment of the thrombus during thrombolysis.
CONCLUSIONS: Because there are currently no guidelines for the use of intravenous thrombolysis for acute ischemic stroke associated with a pre-existing intracardiac thrombus with respect to the efficacy and safety, physicians should pay special attention to similar cases.