Idowu Ahmed O, Sanusi Ahmad A, Balogun Simon A, Anele Christopher O, Adebowale Akintunde A, Abidoye Abdulmajeed K, Akinola Gloria J, Fawale Michael B, Komolafe Morenikeji A
Department of Internal Medicine, Neurology Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ife, NGA.
Department of Surgery, Neurosurgery Unit, Obafemi Awolowo University Teaching Hospitals Complex, Ife, NGA.
Cureus. 2022 Jun 16;14(6):e25996. doi: 10.7759/cureus.25996. eCollection 2022 Jun.
An acute ischemic stroke, though carrying the risk of debilitating complications, is a preventable and treatable disease. Thrombolysis and endovascular thrombectomy are important components of its management. However, various challenges in resource-poor countries like Nigeria and other developing nations pose a great limitation in the timely intervention of ischemic stroke treatment. The challenges include late presentation, poor awareness of stroke symptoms even among health care workers, poor ambulance service/transportation network, intra-hospital delay, particularly in neuroimaging, and the unavailability of tissue plasminogen activator (alteplase/tenecteplase). We report a 32-year-old African man with an antecedent history of suspected migraine headaches with aura and a family history of hypertension and stroke, admitted 7½ hours after onset of stroke symptoms, scoring 13 on the National Institutes of Health Stroke Scale (NIHSS) with Medical Research Council (MRC) muscle power grades 1 and 3 on the right upper and lower extremities, respectively. Urgent non-contrast brain CT revealed only a hyperdense sign in the left middle cerebral artery (MCA). Intravenous tissue plasminogen activator (tPA) was administered at a lower dose of 0.6 mg/kg, 15½ hours after symptom onset, and a CT angiogram done 24 hours post-thrombolysis showed partial recanalization of the M1 segment of the MCA and intermediate collateral supply (Alberta stroke program early CT {ASPECT} score: 6). By the third day of admission, he had made a significant clinical improvement and was discharged home able to walk unsupported on the fourth day.
急性缺血性中风虽然有导致使人衰弱的并发症的风险，但却是一种可预防和可治疗的疾病。溶栓和血管内血栓切除术是其治疗的重要组成部分。然而，在尼日利亚等资源匮乏的国家以及其他发展中国家，各种挑战给缺血性中风治疗的及时干预带来了极大限制。这些挑战包括就诊延迟、即使在医护人员中对中风症状的认知也较差、救护车服务/交通网络不佳、院内延误，尤其是在神经影像学检查方面，以及组织纤溶酶原激活剂（阿替普酶/替奈普酶）无法获取。我们报告了一名32岁的非洲男性，既往有疑似伴有先兆的偏头痛病史，家族中有高血压和中风病史，在中风症状发作7个半小时后入院，美国国立卫生研究院卒中量表（NIHSS）评分为13分，右侧上肢和下肢的医学研究委员会（MRC）肌力分级分别为1级和3级。紧急非增强脑部CT仅显示左侧大脑中动脉（MCA）有高密度征。在症状发作15个半小时后，以较低剂量0.6mg/kg静脉注射组织纤溶酶原激活剂（tPA），溶栓后24小时进行的CT血管造影显示MCA的M1段部分再通，侧支供应中等（阿尔伯塔中风项目早期CT{ASPECT}评分：6）。到入院第三天，他有了显著的临床改善，并在第四天出院回家，能够独立行走。
