Briosa E Gala Diana, Almeida André, Monteiro Nadine, Paiva Nunes Ana, Ferreira Patrícia, Mendonça Nuno, Amaral-Silva Alexandre, Alcântara João
Internal Medicine Department, Centro Hospitalar Leiria-Pombal, EPE, Hospital de Santo André, 2410-197 Leiria, Portugal.
Internal Medicine Department, Centro Hospitalar de Lisboa Central, EPE, Hospital de Santa Marta, 1169-024 Lisboa, Portugal.
Case Rep Neurol Med. 2014;2014:323049. doi: 10.1155/2014/323049. Epub 2014 Nov 24.
Purpose. To report a case of successful thrombolysis performed in a patient with an incidental unruptured intracranial aneurysm and review the literature. Case Report. Patient admitted for ischemic stroke due to left posterior cerebral artery occlusion, with an incidental right middle cerebral artery aneurysm, who underwent treatment with tissue plasminogen activator (rtPA) resulting in clinical improvement without complications. Conclusion. The presence of unruptured intracranial aneurysms is considered as a contraindication to thrombolysis, due to a potentially higher hemorrhagic risk of aneurysm rupture. Patients, otherwise, eligible for thrombolysis are usually excluded from receiving this emergent treatment, despite its potential benefits. A reevaluation of the strict exclusion criteria for thrombolysis in acute stroke patients should be considered.
目的。报告一例对偶然发现的未破裂颅内动脉瘤患者成功进行溶栓治疗的病例并复习相关文献。病例报告。患者因左大脑后动脉闭塞导致缺血性卒中入院，偶然发现右侧大脑中动脉动脉瘤，接受了组织型纤溶酶原激活剂（rtPA）治疗，临床症状改善且无并发症。结论。由于动脉瘤破裂导致出血风险可能更高，未破裂颅内动脉瘤的存在被视为溶栓治疗的禁忌证。否则符合溶栓条件的患者通常会被排除在接受这种紧急治疗之外，尽管其有潜在益处。应考虑对急性卒中患者溶栓的严格排除标准进行重新评估。
