Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs
Lacunar strokes account for about a fourth of all ischemic strokes. Pontine infarcts often present with stuttering symptoms, referred to as pontine warning syndrome (PWS). Patients presenting with fluctuating symptoms can appear to have rapidly improving symptoms and thus often go untreated despite...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2018-12-01
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| Series: | eNeurologicalSci |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405650218300327 |
| _version_ | 1818047233807876096 |
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| author | Imama Naqvi Alexis N. Simpkins Kaylie Cullison Emily Elliott Dennys Reyes Richard Leigh John K. Lynch |
| author_facet | Imama Naqvi Alexis N. Simpkins Kaylie Cullison Emily Elliott Dennys Reyes Richard Leigh John K. Lynch |
| author_sort | Imama Naqvi |
| collection | DOAJ |
| description | Lacunar strokes account for about a fourth of all ischemic strokes. Pontine infarcts often present with stuttering symptoms, referred to as pontine warning syndrome (PWS). Patients presenting with fluctuating symptoms can appear to have rapidly improving symptoms and thus often go untreated despite the risk of recurrent deficits. MRI carries a higher sensitivity in detecting posterior circulation strokes compared to computed topagraphy, but does not always indicate irreversible injury. Here we present the first description of a stuttering lacune, captured radiographically on serial magnetic resonance imaging (MRI), that was initially averted with the administration of intravenous (IV) tissue plasminogen activator (tPA), only to return a month later and progress on imaging despite re-administration of tPA. During the first admission, our patient had spontaneous resolution of symptoms with complete reversal on restricted diffusion soon after IV tPA administration. On the second admission, the stuttering symptoms returned as did the same pontine lesion. Although his stuttering lesions lasted for several days, and the pontine lesion did ultimately progress to partial infarction on MRI, he was discharged home without neurologic deficits. Our case suggests that tPA may be of benefit in patients with lacunar pontine strokes even if symptoms rapidly improve or resolve. Keywords: Thrombolysis, Ischemic stroke, Lacunar infarct, MRI, Small vessel disease, Rapidly improving stroke symptoms, Ischemic tolerance |
| first_indexed | 2024-12-10T10:02:32Z |
| format | Article |
| id | doaj.art-65dbdc8760694c2f9a241190267863f7 |
| institution | Directory Open Access Journal |
| issn | 2405-6502 |
| language | English |
| last_indexed | 2024-12-10T10:02:32Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | eNeurologicalSci |
| spelling | doaj.art-65dbdc8760694c2f9a241190267863f72022-12-22T01:53:19ZengElseviereNeurologicalSci2405-65022018-12-01131417Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIsImama Naqvi0Alexis N. Simpkins1Kaylie Cullison2Emily Elliott3Dennys Reyes4Richard Leigh5John K. Lynch6Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Corresponding author at: Building 10, B1D733 MSC 1063, 10 Center Drive, Bethesda, MD 20892, United States.Section on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United StatesSection on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United StatesWalter Reed National Military Medical Center, Bethesda, MD, United StatesSection on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United StatesSection on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United StatesSection on Stroke Diagnostics and Therapeutics, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United StatesLacunar strokes account for about a fourth of all ischemic strokes. Pontine infarcts often present with stuttering symptoms, referred to as pontine warning syndrome (PWS). Patients presenting with fluctuating symptoms can appear to have rapidly improving symptoms and thus often go untreated despite the risk of recurrent deficits. MRI carries a higher sensitivity in detecting posterior circulation strokes compared to computed topagraphy, but does not always indicate irreversible injury. Here we present the first description of a stuttering lacune, captured radiographically on serial magnetic resonance imaging (MRI), that was initially averted with the administration of intravenous (IV) tissue plasminogen activator (tPA), only to return a month later and progress on imaging despite re-administration of tPA. During the first admission, our patient had spontaneous resolution of symptoms with complete reversal on restricted diffusion soon after IV tPA administration. On the second admission, the stuttering symptoms returned as did the same pontine lesion. Although his stuttering lesions lasted for several days, and the pontine lesion did ultimately progress to partial infarction on MRI, he was discharged home without neurologic deficits. Our case suggests that tPA may be of benefit in patients with lacunar pontine strokes even if symptoms rapidly improve or resolve. Keywords: Thrombolysis, Ischemic stroke, Lacunar infarct, MRI, Small vessel disease, Rapidly improving stroke symptoms, Ischemic tolerancehttp://www.sciencedirect.com/science/article/pii/S2405650218300327 |
| spellingShingle | Imama Naqvi Alexis N. Simpkins Kaylie Cullison Emily Elliott Dennys Reyes Richard Leigh John K. Lynch Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs eNeurologicalSci |
| title | Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs |
| title_full | Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs |
| title_fullStr | Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs |
| title_full_unstemmed | Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs |
| title_short | Recurrent thrombolysis of a stuttering lacunar infarction captured on serial MRIs |
| title_sort | recurrent thrombolysis of a stuttering lacunar infarction captured on serial mris |
| url | http://www.sciencedirect.com/science/article/pii/S2405650218300327 |
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