MRI negative thrombolysis

A 62 year old patient with ethanol abuse and all risk factors develops aphasia, confusion and a brachiofacial paralysis on the right. With some bending of the rules he is rtpa’d (within 5h) and promptly gets better, leaving only pronation of the hand and some dysdiadochokinesia on the right. After 24h he gets his MRI which shows no DWI.

This is actually a very common situation. The (mostly british) rtpa critics (such as emcrit.org) would have a lot to say about the quality of our stroke team if they knew the numbers (fortunately we didn’t do them yet). There are no published studies on this entity. Here are the options:

  • Very successful thrombolysis
  • Stroke mimic
  • MRI-negative ischemia
  • TIA

Obviously, we cannot properly distinguish these, but on heuristic grounds it should be possible.

We discuss the 4 options and case reports for each, reviewing also the revised definition of TIA (whether you like it or not).

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