Abstract
Introduction Lacunar strokes are usually a result of an occluded single perforating cerebral artery. The delayed effects of cranial radiation therapy, in the absence of traditional risk factors, are a well-established aetiology. However, the use of standard hyperacute stroke treatment, intravenous recombinant tissue plasminogen activator factor, in this stroke subtype remains a topic of debate.1 Further, the stuttering TIA-like nature, often seen in cerebral small vessel disease, raises concern regarding the risk of symptomatic intracranial haemorrhage.2
Case In this report, we detail the case of an 18-year-old right-handed survivor of a childhood brain tumour presenting within one hour of a right hemiparesis and non-fluent dysphasia. Through a real-life stroke assessment, we discuss the patient’s clinical syndrome, possible differential diagnoses, the use of perfusion imaging to help identify a dysphasic disconnection syndrome and the evidence behind the use of intravenous recombinant tissues plasminogen activator as it relates to the case.
Conclusions The benefit of intravenous recombinant tissue plasminogen activator factor in acute stroke attributed to small vessel disease is unclear. Further, clinicians should be cautious of its use after a transient ischemia attack given the trend towards increased rates of symptomatic intracranial haemorrhage.
References
Karaszewski B, Wyszomirski A, Jablonski B, Werring DJ, Tomaka D. Efficacy and safety of intravenous rtPA in ischemic strokes due to small-vessel occlusion: systematic review and meta-analysis. Transl Strokes Res. 2021;12:406–415. doi: 10.1007/s12975-021-00890-9
Alonso de Lecinana M, Fuentes B, Masjuan J, et al. Thrombolytic therapy for acute ischemic stroke after recent transient ischemic attack. Int J Stroke. 2012;7(3):213–218. doi: 10.1111/j.1747-4949.2011.00690.x
