Bhandari Sambhawana, Baral Maun R, Espana Schmidt Christian
Internal Medicine, Danbury Hospital, Nuvance Health, Danbury, USA.
Cureus. 2021 Nov 8;13(11):e19346. doi: 10.7759/cureus.19346. eCollection 2021 Nov.
The elderly have a higher incidence of ischemic stroke along with higher mortality and morbidity compared to their younger counterparts. However, though studies have included people >85 or 90 years of age, there haven't been reports of many individuals above 100 years of age. Among the oldest old, the oldest age studied for alteplase administration is possibly 101 years. We present a case of a 105-year-old woman with a medical history of a cerebrovascular accident in 2018 for which she received thrombolytic therapy with residual slurred speech and mild dysphagia. She was brought in from her nursing facility for worsening of slurred speech and right facial droop that began two hours before presentation to the emergency department. She was found to have aphasia, left-sided gaze preference, and upper motor neuron dysfunction of her right arm associated with drift. Her National Institutes of Health Stroke Scale (NIHSS) score at presentation was 17. An urgent CT scan of the head was performed that did not show any evidence of acute bleeding. CT angiogram of brain and neck was unremarkable with no evidence of high-grade stenosis, aneurysm, occlusion, or dissection. With the negative CT findings, the patient received thrombolytic therapy with alteplaseShe was monitored in the intensive care unit for 24 hours after alteplase administration with neurological checks every one hour. The repeated CT head after 24 hours was negative for any hemorrhage. She was discharged after two days of hospital admission and her NIHSS score on the day of discharge was 4. Our patient was 105 years old, which is arguably one of the oldest ages to receive alteplase. Her NIHSS score improved considerably and she did not suffer from hemorrhagic complications.
与年轻人相比，老年人缺血性中风的发病率更高，死亡率和发病率也更高。然而，尽管研究纳入了85岁或90岁以上的人群，但关于100岁以上人群的报道并不多。在最年长者中，接受阿替普酶治疗的最大年龄可能是101岁。我们报告一例105岁女性病例，她在2018年有脑血管意外病史，当时接受了溶栓治疗，仍有言语不清和轻度吞咽困难。她从护理机构被送来，因为在就诊于急诊科前两小时开始出现言语不清加重和右侧面部下垂。检查发现她有失语、左侧凝视偏好以及右臂上运动神经元功能障碍伴漂移。她就诊时的美国国立卫生研究院卒中量表（NIHSS）评分为17分。紧急进行了头部CT扫描，未显示任何急性出血迹象。脑部和颈部的CT血管造影无异常，没有高级别狭窄、动脉瘤、闭塞或夹层的证据。由于CT检查结果为阴性，患者接受了阿替普酶溶栓治疗。在给予阿替普酶后，她在重症监护病房监测了24小时，每小时进行一次神经学检查。24小时后复查头部CT未发现任何出血。入院两天后她出院了，出院当天她的NIHSS评分为4分。我们的患者为105岁，这可以说是接受阿替普酶治疗的最高龄患者之一。她的NIHSS评分有显著改善，且未出现出血并发症。
