BACKGROUND

Recombinant Tissue Plasminogen Activator therapy has been recommended as the standard treatment for acute ischemic stroke. The experience in the Philippines is still limited.

OBJECTIVE

We evaluated the clinical profile and outcome of our acute ischemic stroke patients who underwent thrombolysis.

PATIENTS AND METHODS

Ten cases from a retrospectively collected database of patients with acute ischemic stroke who presented within 3 hour of onset were screened under the Brain Attack Team Program. Those eligible were treated with thrombolysis with recombinant tissue plasminogen activator (rt-PA) at 0.9 mg/kg, and or bridging therapy with intravenous and intraarterial for those beyond the therapeutic window. General and neurological examinations together with the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) were recorded prior to and after the treatment at 1 hour, 24 hour, on discharge. Hemorrhagic brain lesion and death within discharge were also recorded.

RESULTS

The mean pretreatment NIHSS score was 18 and most of the patients had anterior circulation infarction. The mean door-to-treatment time was 170 min (ranged 60-400 min). lntracerebral hemorrhage was detected in three cases, and one was fatal.

CONCLUSION

Thrombolytic therapy can be given in patients with acute stroke without down-titrating the dose in our population. The risk of hemorrhagic brain lesion is not much higher compared to other studies.

Human ; Female ; Humans ; ; Tissue Plasminogen Activator ; ; Stroke ; ; Brain Ischemia ; ; Philippines ; ; Infarction ; ; Time-to-treatment ; ; Thrombolytic Therapy ; ; Cerebral Hemorrhage ; ; Neurologic Examination ; ; National Institutes Of Health (u.s.) ; ; Brain ; ; Retrospective Studies

OBJECTIVES: Sporadic inclusion body myositis (s-IBM) is characterized by progressive muscle weakness and inclusion bodies on muscle biopsy and is the most common type of myopathy in patients over 50 years old. However, it is not only under-diagnosed but also frequently misdiagnosed as polymyositis hence treated with steroids. In the evaluation of progressive weakness in older males, S-IBM should be investigated. This case report and literature review is presented to explore these issues. A discussion on the clinical and laboratory manifestations and histopathological findings are also included.

REPORT OF THE CASE: A 42-year-old male presented with six-year history of a slowly progressive weakness seen as difficulty brushing his teeth, buttoning his shirt, tying his shoelaces, associated with progressive dysphagia. He undergone EMGNCV of all extremities and was given a provisional diagnosis of facioscapulohumeral dystrophy. He was treated with Prednisone 5 mg/tab, 2 tablets twice a week, which he took for 2 years but afforded no relief. The weakness progressed, and he eventually required assistance to walk. Pertinent on general physical examination was severe, diffuse, symmetric muscle atrophy. Neurologic examination was consistent with proximal muscle weakness. Diagnostics showed normal CPK and ESR. Muscle biopsy revealed rimmed vacuoles, mononuclear inflammatory infiltrates, tubulofilaments which suggests a diagnosis of sporadic inclusion body myositis.

CONCLUSION: Though s-IBM is the most common myopathy in patients over 50 years of age, its symptoms can start up to 20 years earlier. Hence in the evaluation of progressive weakness in adult males, s-IBM should be an important diagnostic consideration.

Human ; Male ; Myositis, Inclusion Body ; Muscle Weakness ; Prednisone ; Vacuoles ; Deglutition Disorders ; Polymyositis ; Muscular Dystrophy, Facioscapulohumeral ; Neurologic Examination ; Muscular Atrophy ; Inclusion Bodies ; Biopsy ; Tablets