Thrombolysis may be safely given in an acute stroke patient with Marfan’s syndrome: A case report
- Author:
Yexian Jonathan Lai
;
Oh Chia Theng Daniel Oh
- Publication Type:Case Reports
- Keywords:
Marfan’s syndrome, ischaemic stroke, thrombolysis, dissection
- From:Neurology Asia
2020;25(3):383-386
- CountryMalaysia
- Language:English
-
Abstract:
Marfan’s syndrome is a systemic disorder of connective tissue typically involving cardiovascular,
musculoskeletal and ocular systems. Given the relative rarity of neurovascular complications in
Marfan’s syndrome, there is currently little published data on the use of thrombolysis in patients
with Marfan’s syndrome and acute ischaemic stroke. Of concern is the possibility of underlying
cerebral artery dissection in patients with Marfan’s syndrome presenting with stroke and the risk
of haemorrhagic complications with thrombolysis. We report the third known case of a patient with
Marfan’s syndrome with an acute ischaemic stroke without evidence of cerebral artery dissection who
received thrombolysis successfully with neurological improvement. A 47-year-old woman with a history
of Marfan’s syndrome and previous left middle cerebral artery (MCA) territory infarct presented to our
emergency department with sudden onset of right facial, arm and leg weakness with a NIHSS score of
15 and clinical examination findings of a right upper motor neurone facial palsy and right hemiparesis.
CT brain revealed a dense right MCA sign and no evidence of haemorrhage. She received 0.9mg/kg
of alteplase without complications. There was a suspicion for cerebral artery dissection but this was
not evident on both CT angiography and MRI angiogram with black blood sequences. She recovered
well with a NIHSS score of 1 and mild residual dysphasia. This case demonstrates that thrombolysis
may be given safely in a patient with Marfan’s syndrome and acute ischaemic stroke and exclusion
of underlying cerebral artery dissection should always be a consideration.
- Full text:7.2020my0056.pdf
