BACKGROUND

Thrombolysis, or the administration of intravenous recombinant tissue plasminogen activator (IV rTPA) within the narrow therapeutic window following ischemic stroke onset, has emerged as a critical intervention in acute stroke care with the potential to restore blood flow and improve chances of functional recovery.

OBJECTIVES

This study aimed to describe the demographic profile, risk factors, ischemic stroke subtypes, clinical course, and outcomes of stroke thrombolysis in a tertiary hospital in the Philippines over the past five years. It also aimed to evaluate key performance indicators in terms of benchmark times in the administration of IV rTPA.

METHODS

This study used a retrospective observational design including all adult acute ischemic stroke patients who received IV rTPA at the University of the Philippines - Philippine General Hospital (UP-PGH). Data was collected through census and chart review.

RESULTS

One hundred eighty-eight patients received IV rTPA, majority were males (57.45%) with a median age of 60 years old. Hypertension (76.60%) was the most common risk factor for ischemic stroke. Partial anterior circulation infarcts (67.55%) and large artery atherosclerosis (49.47%) were the most common ischemic stroke subtype and etiology, respectively. The median door to needle time was 48 minutes, and the median length of hospital stay was five days. There was improvement in median NIHSS from 13 to 4, with a median modified Rankin scale of 3 indicating moderate disability upon discharge. Less than five percent (4.79%) had symptomatic intracerebral hemorrhage. The inhospital all-cause mortality rate among thrombolysed patients was 13.83%, mostly from non-neurologic causes. Nosocomial pneumonia and the need for neurosurgical interventions after thrombolysis were significantly associated with poor outcome (p < 0.05).

CONCLUSION

Our findings support the use of IV rTPA in the treatment of acute ischemic stroke. Existing stroke protocols in our institution are able to achieve the recommended thrombolysis benchmark times, leading to better functional outcomes for stroke patients.

Human ; Ischemic Stroke ; Philippines

Endovascular thrombectomy (EVT) has revolutionized the management of acute ischemic stroke (AIS) caused by large-vessel occlusion, significantly improving outcomes worldwide. This single-center case series evaluated the early outcomes of EVT in AIS patients treated at this institution, focusing on its implications within a low- or middleincome country setting. The study aimed to assess the feasibility, safety, and efficacy of EVT, analyzing premorbid comorbidities, time to treatment, revascularization rates, procedural complications, and clinical outcomes. Five consecutive cases of AIS due to large-vessel occlusion treated with EVT were analyzed. The patients in this series were aged 21 to 75 years, all with a baseline modified Rankin Scale (mRS) score of 0. The average NIH Stroke Scale (NIHSS) score on admission was 17. Four patients received Alteplase before EVT within four hours of symptom onset. Successful recanalization (TICI 2b-3) was achieved in all cases. Post-thrombectomy, two patients developed re-occlusion, with one resulting in mortality. Among the patients, 40% achieved a favorable outcome, defined as a modified Rankin Scale (mRS) score of 2 at three months. This initial experience demonstrates promising results in achieving successful recanalization and improving clinical outcomes in AIS patients with large-vessel occlusion. However, the study also highlights challenges such as procedural complications and post-thrombectomy re-occlusion, underscoring the need for ongoing evaluation and optimization of patient selection and procedural protocols in lowresource settings. Future studies with larger sample sizes are warranted to further validate these findings and refine EVT protocols tailored to local healthcare contexts.

Human ; Ischemic Stroke ; Thrombectomy ; Time-to-treatment

We describe an unusual case of hypoxic ischemic encephalopathy in a preterm female of 36 weeks who presented with status epilepticus and atypical abdominal myoclonus. The seizures were confirmed electrographically using video electroencephalography (EEG), while the abdominal myoclonus was demonstrated to be nonepileptic, as it had no EEG correlate. Other possible causes of neonatal seizures were excluded. The infant then responded to a gamut of antiseizure medications but the myoclonus persisted. To the best of our knowledge, this is the first report of atypical myoclonus in a preterm baby caused by hypoxic ischemic encephalopathy.

Human ; Hypoxic Ischemic Encephalopathy ; Hypoxia-ischemia, Brain ; Status Epilepticus ; Myoclonus ; Neonate ; Infant, Newborn