Caliandro Pietro, Reale Giuseppe, Tartaglione Tommaso, Rossini Paolo Maria
Institute of Neurology, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Fondazione Don Carlo Gnocchi Onlus, Milan, Italy.
Neurol Sci. 2016 Jul;37(7):1137-40. doi: 10.1007/s10072-016-2539-4. Epub 2016 Mar 10.
We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.
我们描述了一名被送至我院急诊科的患者的病例，其苏醒时出现构音障碍、右侧偏瘫及意识障碍加重（美国国立卫生院卒中量表评分12分）。在进行CT血管造影显示基底动脉完全闭塞后，我们通过磁共振弥散加权成像（DWI）与液体衰减反转恢复序列（FLAIR）不匹配来估算卒中发病时间。由于存在良好的不匹配情况（左侧脑桥DWI高信号，同一区域无FLAIR高信号），该患者接受了溶栓治疗，神经功能随即出现改善。此外，溶栓后最初在左侧脑桥观察到的DWI高信号完全消退。醒后卒中约占所有卒中的14%，而基底动脉闭塞性醒后卒中的比例仍不清楚。尽管对发病时间不明的患者进行溶栓治疗仍属于超说明书用药，但基底动脉闭塞是一种潜在的致命事件。在我们的病例中，我们利用磁共振DWI-FLAIR不匹配来快速估算卒中发病时间，并采用一种超说明书但可能有效且安全的疗法对患者进行治疗。
