An emergency patient referral in such a life-threatening thromobembolic complication caused massive ischemic cerebral infarction. Fibrinolysis is a savior for stroke but can also be a disaster when it comes to complications.
Case patient: Mr. Tran Thanh T. (Male - 63 years old, living in Dong Nai). Information shared by the patient's daughter: “a week ago, my father showed signs of dizziness, sudden numbness on the right side of the body with a transient cramp while working on the field and then quit a few minutes later. However, he decided not to get any type of checkup, then he got stroke while sleeping."
The patient got admitted to a local hospital at midnight by a family emergency with a right-sided paralysis, but consciousness was fully awake. After a doctor's visit, Mr. Thanh T. suffered from acute cerebral infarction and indicated for blood fibrinolysis (rTPA). After the infusion, the patient recovered immediately in the right half of his body.
Patient with severe hemispheric stroke caused by fibrinolytic agents
2 hours after I had thought I was safe, I got a sudden severe headache, irritability, soaring blood pressure and fell into a a comatose state. Brain CT scan showed a severe hemorrhage due to the activation of plasminogen caused by fibrinolytic agents in unwanted sides. The patient then received emergency resuscitation, intubation ventilation, and follow-up care in the intensive care unit progressively.
In this regard his family determined “Never give up and think positive all the time” and decided to come to Ho Chi Minh City for treatment opportunities. Along with emergency referrals, the patient's medical records got sent to City International Hospital, the patient is in a state of mechanical ventilation, deep coma (Glasgow 5-6 points). A unique multidisciplinary meeting immediately gathered in-house top doctors and a severe hemorrhage complication after using fibrinolytic drugs was found and determined an urgent intervention needed for treatment of acute cerebral infarction.
A Brain CT result revealed a homogeneous density ASDH in the right frontal, and traumatic brain injury,. A contusion causes bleeding and swelling inside of the brain around the area where the head was struck. and it increases morbidity and mortality associated with them. CIH’s neurointensivists spent significant amounts of time monitoring for the presence of cerebral edema and managing its consequences, this is the focus of the current review. Lab testing showed an amount of fibrinogen dropped below 1g / L due to the effect of fibrinolytic agents.
Post-operatively, Mr. Thanh T. recovered well
To restore coagulation function impaired by acidosis, and then a Craniotomy performed to treat brain tumors, hematomas (blood clots) and relieve pressure in the swollen area. After the surgeon repaired the problem, the bone flap is then replaced or covered with plates and screws. The interventional procedure went flawlessly well, the patient was then put under postoperative intensive care to limit hemorrhagic complications. After 14 days of deep coma, patient perception gradually recovered. On May 21, the patient was fully awake, Muscle weakness on the right side of the body, but eating well and able to start walking.
Dr. Dao Thi My Van - deputy medical director of CIH recommends: the risk of brain stroke may occur without exception, the rate of occurrence will increase with age and on patients with many risk factors attached such as high blood pressure, diabetes, obesity, and other cardiovascular diseases. In some cases, patients may experience transient ischemic attacks such as numbness or weakness in one arm, numbness in the half, distortion of the mouth, difficulty speaking, difficulty swallowing, etc. patients need to see a Neurologist for timely intervention and treatment, to prevent life-threatening stroke risk.
Dr. My Van - also added: "The introduction of Recombinant Tissue Plasminogen Activator as a savior which helps to significantly reduce mortality and disability for patients with stroke due to cerebral infarction. However, only fibrinolytic agents actually save the patient's life only when being used correctly. The most serious complication of death after using fibrinolysis is the transformation of cerebral hemorrhage so the drug is only allowed to be used by specialists. If the medical facility does not meet the treatment conditions when there are hemorrhagic complications, care should be taken when deciding to take the medicine. ”
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