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Neurología, Neurocirugía y Psiquiatría

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2021, Number 1

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Rev Neurol Neurocir Psiquiat 2021; 49 (1)

Successful intravenous thrombolysis in acute cerebral infarction in a patient with a history of macroadenoma and hypophysial stroke

Romero C, Gaviria M, Mutis JA
Full text How to cite this article 10.35366/101751

DOI

DOI: 10.35366/101751
URL: https://dx.doi.org/10.35366/101751

Language: Spanish
References: 9
Page: 19-22
PDF size: 224.84 Kb.


Key words:

Ischemic stroke, pituitary macroadenoma, pituitary apoplexy, intravenous thrombolysis, tissue plasminogen activator.

ABSTRACT

Thrombolysis with tissue plasminogen activator is probably recommended for patients with acute ischemic stroke and extra-axial intracranial neoplasm, but in those with a history of intracranial hemorrhage it is potentially harmful. Intravenous thrombolysis in acute ischemic stroke in patients with a history of pituitary macroadenoma and apoplexy with intratumoral bleeding has not been reported in the literature. We report the case of a young patient with an acute ischemic stroke in the territory of the left middle cerebral artery, M3 portion, National Institutes of Health Stroke Scale of 14 and modified Rankin scale of 0 at admission, with a history of pituitary macroadenoma and pituitary apoplexy and mild intratumoral bleeding successfully brought to intravenous thrombolysis. The decision to thrombolysis with tissue plasminogen activator for the management of acute ischemic stroke should be based on the evaluation of the expected risks and benefits on a case-by-case basis taking into account the current guidelines.


REFERENCES

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  2. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke:2019 update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke 2019;50:e344-e418.

  3. Lee SH, Kim BJ, Han MK, Park TH, Lee KB, Lee BC, et al. Should we exclude acute stroke patients with previous intracerebral hemorrhage from receiving intravenous thrombolysis? Int J Stroke 2016;11(7):783-790.

  4. Serramito R, Santín JM, Román P, Pita L, González L. Infarto cerebral tras apoplejía pituitaria: descripción de un caso y revisión de la literatura. Neurocirugía 2016;27:310-314.

  5. Vargas G, González B, Guinto G, Mendoza V, López B, Zepeda E, et al. Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study. Endocr Prac 2014;20(12):1274-1280.

  6. Nawar RN, Abdel-Mannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med 2008;23(2):75-90.

  7. Kaplan B, Day AL, Quisling R, Ballinger W. Hemorrhage into pituitary adenomas. Surg Neurol 1983;20(4):280-287.

  8. Ahmed SK, Semple PL. Cerebral ischemia in pituitary apoplexy. Acta Neurochir (Wien) 2008;150(11):1193-1196.

  9. Rubinshtein R, Jaffe R, Flugelman MY, Karkabi B, Lewis BS. Thrombolysis in patients with a brain tumor. Heart 2004;90(12):1476.




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Rev Neurol Neurocir Psiquiat. 2021;49