Centenarian stroke treated with tissue-type plasminogen activator

被引:14
作者
Gorman, MJ
Tanne, D
Lewandowski, CA
机构
[1] Wayne State Univ, Sch Med, Dept Neurol, Stroke Program, Detroit, MI 48201 USA
[2] Henry Ford Hlth Sci Ctr, Dept Emergency Med, Detroit, MI USA
[3] Chaim Sheba Med Ctr, Dept Neurol, Stroke Unit, IL-52621 Tel Hashomer, Israel
关键词
stroke; thrombolysis; elderly; tissue-type plasminogen activator;
D O I
10.1159/000057857
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Elderly patients with acute ischemic stroke often do worse than younger counterparts independent of thrombolytic therapy. Further, tissue-type plasminogen activator, (t-PA) is frequently withheld from the very old. This may be the result of comorbid conditions prohibiting its use or possibly the fear of causing more harm than good. We present a case of a 100-year-old woman who was treated with t-PA for acute ischemic stroke with rapid resolution of symptoms. Case Description: A 100 year-old woman presented to the emergency department with slurred speech, right hemiparesis and right hemisensory loss. Computed tomography revealed neither hemorrhage nor early ischemic changes. Intravenous t-PA was administered at 0.9 mg/kg 3 min prior to the 3-hour limit. She improved rapidly (NIHSS from 12 on admission to 4 at 1 month) and was discharged to the care of her family after 4 hospital days. Conclusion: Intravenous thrombolysis may be beneficial in the very elderly and should be considered in any eligible elderly patients with acute ischemic stroke, with a risk/benefit analysis individualized to each case. Copyright (C) 2002 S. Karger AG, Basel.
引用
收藏
页码:285 / 287
页数:3
相关论文
共 28 条
[1]   CAROTID ENDARTERECTOMY - A SAFE AND EFFECTIVE THERAPY FOR ELDERLY PATIENTS [J].
ADAMS, HP .
MAYO CLINIC PROCEEDINGS, 1991, 66 (05) :539-543
[2]   Guidelines for thrombolytic therapy for acute stroke: A supplement to the guidelines for the management of patients with acute ischemic stroke - A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association [J].
Adams, HP ;
Brott, TG ;
Furlan, AJ ;
Gomez, CR ;
Grotta, J ;
Helgason, CM ;
Kwiatkowski, T ;
Lyden, PD ;
Marler, JR ;
Torner, J ;
Feinberg, W ;
Mayberg, M ;
Thies, W .
CIRCULATION, 1996, 94 (05) :1167-1174
[3]   Intravenous tissue-type plasminogen activator for treatment of acute stroke - The standard treatment with alteplase to reverse stroke (STARS) study [J].
Albers, GW ;
Bates, VE ;
Clark, WM ;
Bell, R ;
Verro, P ;
Hamilton, SA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (09) :1145-1150
[4]   STROKE IN THE ELDERLY AGED 75 YEARS AND ABOVE - A STUDY FROM SAUDI-ARABIA [J].
ALRAJEH, S .
CEREBROVASCULAR DISEASES, 1994, 4 (06) :402-406
[5]   Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility [J].
Barber, PA ;
Zhang, J ;
Demchuk, AM ;
Hill, MD ;
Buchan, AM .
NEUROLOGY, 2001, 56 (08) :1015-1020
[6]   Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke [J].
Brott, T ;
Broderick, J ;
Kothari, R ;
ODonoghue, M ;
Barsan, W ;
Tomsick, T ;
Spilker, J ;
Miller, R ;
Sauerbeck, L ;
Farrell, J ;
Kelly, J ;
Perkins, T ;
Miller, R ;
McDonald, T ;
Rorick, M ;
Hickey, C ;
Armitage, J ;
Perry, C ;
Thalinger, K ;
Rhude, R ;
Schill, J ;
Becker, PS ;
Heath, RS ;
Adams, D ;
Reed, R ;
Klei, M ;
Hughes, A ;
Anthony, J ;
Baudendistel, D ;
Zadicoff, C ;
Rymer, M ;
Bettinger, I ;
Laubinger, P ;
Schmerler, M ;
Meiros, G ;
Lyden, P ;
Dunford, J ;
Zivin, J ;
Rapp, K ;
Babcock, T ;
Daum, P ;
Persona, D ;
Brody, M ;
Jackson, C ;
Lewis, S ;
Liss, J ;
Mahdavi, Z ;
Rothrock, J ;
Tom, T ;
Zweifler, R .
STROKE, 1997, 28 (11) :2109-2118
[7]   Generalized efficacy of t-PA for acute stroke - Subgroup analysis of the NINDS t-PA stroke trial [J].
Brott, T ;
Broderick, J ;
Kothari, R ;
ODonoghue, M ;
Barsan, W ;
Tomsick, T ;
Spilker, J ;
Miller, R ;
Sauerbeck, L ;
Farrell, J ;
Kelly, J ;
Perkins, T ;
Miller, R ;
McDonald, T ;
Rorick, M ;
Hickey, C ;
Armitage, J ;
Perry, C ;
Thalinger, K ;
Rhude, R ;
Schill, J ;
Becker, PS ;
Heath, RS ;
Adams, D ;
Reed, R ;
Klei, M ;
Hughes, A ;
Anthony, J ;
Baudendistel, D ;
Zadicoff, C ;
Rymer, M ;
Bettinger, I ;
Laubinger, P ;
Schmerler, M ;
Meiros, G ;
Lyden, P ;
Dunford, J ;
Zivin, J ;
Rapp, K ;
Babcock, T ;
Daum, P ;
Persona, D ;
Brody, M ;
Jackson, C ;
Lewis, S ;
Liss, J ;
Mahdavi, Z ;
Rothrock, J ;
Tom, T ;
Zweifler, R .
STROKE, 1997, 28 (11) :2119-2125
[8]   Intravenous tissue plasminogen activator for acute ischemic stroke - A Canadian hospital's experience [J].
Chapman, KM ;
Woolfenden, AR ;
Graeb, D ;
Johnston, DCC ;
Beckman, J ;
Schulzer, M ;
Teal, PA .
STROKE, 2000, 31 (12) :2920-2924
[9]   Intravenous tissue plasminogen activator for acute ischemic stroke: Feasibility, safety, and efficacy in the first year of clinical practice [J].
Chiu, D ;
Krieger, D ;
Villar-Cordova, C ;
Kasner, SE ;
Morgenstern, B ;
Bratina, PL ;
Yatsu, FM ;
Grotta, JC .
STROKE, 1998, 29 (01) :303-303
[10]   COMPARISON OF OUTCOME IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION AGED GREATER-THAN-75 YEARS WITH THAT IN YOUNGER PATIENTS [J].
DEVLIN, W ;
CRAGG, D ;
JACKS, M ;
FRIEDMAN, H ;
ONEILL, W ;
GRINES, C .
AMERICAN JOURNAL OF CARDIOLOGY, 1995, 75 (08) :573-576