Thrombolysis in Patients With Marked Clinical Fluctuations in Neurologic Status Due to Cerebral Ischemia

Abstract

Background: It is unclear whether thrombolysis benefits patients with fluctuating neurologic symptoms. Objective: To evaluate the clinical course of patients with acute stroke who presented with marked fluctuations in neurologic status and received thrombolytic therapy.

Transient Ischemic Attack Patients with Fluctuations Are at Highest Risk for Early Stroke

“…migraine attacks with focal signs). However, this management may be worthwhile as recently reported by Ozdemir et al [9], who showed that 13/127 patients (10.2%) with clinical fluctuations, all receiving thrombolytic therapy, had favorable neurological and functional outcomes. This could be facilitated if these patients are admitted to an SU – and are carefully monitored to identify early complications just in time for thrombolysis.…”

Transient Ischemic Attack Patients with Fluctuations Are at Highest Risk for Early Stroke

“…migraine attacks with focal signs). However, this management may be worthwhile as recently reported by Ozdemir et al [9], who showed that 13/127 patients (10.2%) with clinical fluctuations, all receiving thrombolytic therapy, had favorable neurological and functional outcomes. This could be facilitated if these patients are admitted to an SU – and are carefully monitored to identify early complications just in time for thrombolysis.…”

Anterior Cerebral Artery Strokes with Isolated Supplementary Motor Area Involvement Presenting with Fluctuating Deficits

“…5 This rapid change in deficits, predominantly worsening, has been described in the literature for strokes in general and has been postulated to be secondary to penumbra dynamics, oedema, haemorrhagic transformation, seizures, blood pressure fluctuation or rarely even psychogenic factors. 2, 3 The cases described here uniquely had waxing and waning of symptoms, for which we have coined the term ‘pendular stroke’, referring to the fluctuating deficits (FDs).…”

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19 Early fluctuation of stroke symptoms is thought to arise from large or small vessel recanalization, reocclusion, and recruitment or collapse of collaterals. 20,21 It has also been described in TIAs 22 and classically in the capsular warning syndrome.…”

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19…”

Transient Ischemic Attack Patients with Fluctuations Are at Highest Risk for Early Stroke

“…migraine attacks with focal signs). However, this management may be worthwhile as recently reported by Ozdemir et al [9], who showed that 13/127 patients (10.2%) with clinical fluctuations, all receiving thrombolytic therapy, had favorable neurological and functional outcomes. This could be facilitated if these patients are admitted to an SU – and are carefully monitored to identify early complications just in time for thrombolysis.…”

Anterior Cerebral Artery Strokes with Isolated Supplementary Motor Area Involvement Presenting with Fluctuating Deficits

“…5 This rapid change in deficits, predominantly worsening, has been described in the literature for strokes in general and has been postulated to be secondary to penumbra dynamics, oedema, haemorrhagic transformation, seizures, blood pressure fluctuation or rarely even psychogenic factors. 2, 3 The cases described here uniquely had waxing and waning of symptoms, for which we have coined the term ‘pendular stroke’, referring to the fluctuating deficits (FDs).…”

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19 Early fluctuation of stroke symptoms is thought to arise from large or small vessel recanalization, reocclusion, and recruitment or collapse of collaterals. 20,21 It has also been described in TIAs 22 and classically in the capsular warning syndrome.…”

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19…”

Transient Ischemic Attack Patients with Fluctuations Are at Highest Risk for Early Stroke

“…migraine attacks with focal signs). However, this management may be worthwhile as recently reported by Ozdemir et al [9], who showed that 13/127 patients (10.2%) with clinical fluctuations, all receiving thrombolytic therapy, had favorable neurological and functional outcomes. This could be facilitated if these patients are admitted to an SU – and are carefully monitored to identify early complications just in time for thrombolysis.…”

Anterior Cerebral Artery Strokes with Isolated Supplementary Motor Area Involvement Presenting with Fluctuating Deficits

“…5 This rapid change in deficits, predominantly worsening, has been described in the literature for strokes in general and has been postulated to be secondary to penumbra dynamics, oedema, haemorrhagic transformation, seizures, blood pressure fluctuation or rarely even psychogenic factors. 2, 3 The cases described here uniquely had waxing and waning of symptoms, for which we have coined the term ‘pendular stroke’, referring to the fluctuating deficits (FDs).…”

Frequency and Prognostic Significance of Clinical Fluctuations Before Hospital Arrival in Stroke

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19 Early fluctuation of stroke symptoms is thought to arise from large or small vessel recanalization, reocclusion, and recruitment or collapse of collaterals. 20,21 It has also been described in TIAs 22 and classically in the capsular warning syndrome.…”

“…18 Another study showed that 10% of patients had a very early 4-point (or greater) improvement or worsening in their NIHSS between arrival and treatment decision. 19…”