Ischemic Stroke Following Thrombolytic Therapy for Acute Inferior Myocardial Infarction: The Third Reported Case
A. Abouriche *
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
H. Bendahou
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
L. Laklalech
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
M. Haboub
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
S. Arous
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
G. Bennouna
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
A. Drighil
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
L. Azzouzi
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
R. Habbal
Department of Cardiology, Hospital University Center Ibn Rochd, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Ischemic stroke following thrombolysis for ST-segment elevation myocardial infarction(STEMI) is a rare and perplexing complication. We present an intriguing case of ischemic stroke following fibrinolytic therapy with tenecteplase for a STEMI.
This is an extremely rare condition, and our case appears to be the third one reported in our departement. The three cases had one thing in common: ST-segment elevation in the inferior leads.
Case Presentation: We describe the case of a 50-year-old north-african woman who suffered an acute inferior STEMI 6 hours after chest pain onset. Thrombolysis with tenecteplase was performed and few hours later an extensive right sylvian artery stroke occurred with subfalcine herniation.
Decision-Making: The refractory intracranial hypertension despite medical therapy compelled a decompressive craniectomy. On the follow up, neurological deficits had increased, congestive heart failure developed, and finally the patient died on the tenth day in the intensive care unit.
Conclusion: Hemorrhagic complications are not the only one, ischemic stroke can also occur after thrombolysis even if it is extremely odd. The pathophysiology is still poorly established.
The prevalent implication of the inferior territory in the three cases described in the literature may open to future research prospects.
Keywords: Acute ST-elevation myocardial infarction, thrombolytic therapy, ischemic stroke, complication of treatment