Purposeof Review: Stroke is an uncommon cause of amnesia. We describe in detail three cases of anterograde amnesia and confabulation secondary to acute ischemic stroke and review the available literature.Recent Findings:In our case series, all three patients presented with anterograde amnesia and two of three co-presented with prominent confabulation. These symptoms were recognized in delayed fashion and no patients received IV tPA. Although stroke infarct topology was variable, all three patients had infarction of the fornix. Long-term follow-up was obtained in two of three patients: both had persistent memory impairment and were no longer functionally independent.Summary:Acute onset anterograde amnesia and confabulation may uncommonly represent acute ischemic stroke. Delays in this diagnosis typically exclude patients from emergent stroke treatment or timely diagnostic stroke evaluation. Physicians should maintain a high degree of suspicion, especially in patients with comorbid vascular risk factors. Memory impairment secondary to ischemic stroke can produce considerable long-term disability.
Introduction: Intravenous Alteplase is currently the only approved medical therapy for treatment of acute ischemic stroke (AIS). Although complications are uncommon, AIS patients receiving IV Alteplase are routinely transferred to higher level stroke centers for monitoring. This resource intensive treatment paradigm is of unclear medical benefit. Methods: We reviewed the stroke thrombolysis database of a single comprehensive stroke center. All presumed AIS patients who received IV Alteplase without thrombectomy from 01/01/2015 to 12/31/2019 were included. Baseline demographics including age, sex, race, ethnicity, comorbidities, and NIHSS were abstracted. Complication rates including angioedema, intracranial and extracranial hemorrhage were recorded. To determine the utility of routine transfer, medical and surgical/neurosurgical interventions to treat complications of Alteplase administration were studied. Complication rates in the transfer and non-transfer cohorts were compared via Fischer’s exact test. Results: Three hundred eighteen patients were reviewed and 222 consecutive AIS patients (median age 67 [IQR 55.5-77], female 48.6%, median NIHSS 5 [IQR 2-10], transfers 54.5%) were eligible for our analysis. Complication rates were not statistically different between transfer and non-transfer patients. Four (1.8%) patients suffered symptomatic intracranial hemorrhage (sICH). All sICH patients received cryoprecipitate and aggressive blood pressure management; none underwent emergent neurosurgical intervention. Conclusion: The overall rate of complications post-Alteplase administration for AIS patients was similarly low between transfer and non-transfer patients. These findings call into question the utility of routine transfer of AIS patients treated with Alteplase. Further study of alternative post-Alteplase monitoring strategies, including remote specialist management via telemedicine, should be considered.
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