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A case of acute ischemic stroke: optimizing management with penumbra and vessel imaging

Nature Clinical Practice Neurology volume 3, pages 465–469 (2007)Cite this article

Abstract

Background An 83-year-old woman with a history of hypertension and dyslipidemia developed acute onset of impaired speech and comprehension, and right-sided weakness. Her previous medical history was notable for hyperthyroidism and a curative remote mastectomy for breast cancer. The patient was on two antihypertensive medications and a statin, and she was not receiving any antiplatelet medication. She was taken by ambulance to a primary stroke center. Initial examination showed global aphasia, right homonymous hemianopia, right hemiplegia, and hemisensory loss.

Investigations Physical examination, laboratory tests, noncontrast head CT scan, multimodal brain MRI scan, catheter cerebral angiogram, echocardiogram, continuous cardiac monitoring.

Diagnosis Acute ischemic stroke caused by distal left internal carotid artery occlusion, with salvageable penumbral tissue and a persistent large-vessel occlusion.

Management Neuroprotective study agent (total dose of 20 g intravenous MgSO4 or matched placebo), intravenous tissue plasminogen activator, rescue mechanical thrombectomy using the Merci® clot retrieval device.

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Figure 1: Serial MRI scans of the patient's brain performed before treatment with the Merci® clot retrieval device and 5 days after therapy

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Acknowledgements

BH Buck is supported by a fellowship award from the Heart and Stroke Foundation of Canada.

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Authors and Affiliations

  1. BH Buck is a Fellow of the Division of Neurology in the Department of Medicine, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada.,

    Brian H Buck

  2. JL Saver is Director of the UCLA Stroke Centre and Professor of Neurology at University of California Los Angeles, Los Angeles, CA, USA.,

    Jeffrey L Saver

Authors
  1. Brian H Buck
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  2. Jeffrey L Saver
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Corresponding author

Correspondence to Brian H Buck.

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Competing interests

JL Saver is Principal Investigator of the NIH FAST–MAG Trial, is an investigator in the NIH MR RESCUE, IMS 3 and CLEAR trials, is on the Scientific Advisory Board and Speaker's Bureau for Boehringer Ingelheim (secondary prevention) and has received speaking honoraria from Concentric Medical. BH Buck declared no competing interests.

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Buck, B., Saver, J. A case of acute ischemic stroke: optimizing management with penumbra and vessel imaging. Nat Rev Neurol 3, 465–469 (2007). https://doi.org/10.1038/ncpneuro0553

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