CASE REPORT

A left MCA territory infarction during intravenous recombinant tissue plasminogen activator therapy for right MCA territory ischaemic stroke

C-C Lai¹ and C-J Hu²

¹ Department of Emergency Medicine, Taipei Municipal Jen-Ai Hospital, Taiwan
² Department of Neurology, Taipei Municipal Jen-Ai Hospital, Taiwan

Correspondence to:
Correspondence to:
Dr C-J Hu
Department of Neurology, Taipei Municipal Jen-Ai Hospital, 10, Sec 4, Jen-Ai Road, Taipei, Taiwan; mimin{at}seed.net.tw

An 81 year old man with a history of hypertension received intravenous recombinant tissue plasminogen activator (tPA) for right middle cerebral artery (MCA) infarction. He had not had stroke or arrhythmia previously. The initial National Institute of Health Stroke Scale (NIHSS) score was 8. However, a left MCA territory infarction developed 2 minutes after the full course of tPA therapy was completed, and 24 hours after tPA infusion, NIHSS score was 17. The subsequent magnetic resonance imaging scan confirmed an extensive left MCA territory infarction and a small right MCA territory infarction. Although the intracerebral haemorrhage after tPA therapy is relatively more common, tPA infusion may result in an ischaemic cerebral stroke in rare cases.

Abbreviations: ED, emergency department; GCS, Glasgow Coma Score; ICH, intracerebral haemorrhage; MCA, middle cerebral artery; MRI, magnetic resonance imaging; NIHSS, National Institute of Health Stroke Scale; tPA, tissue plasminogen activator

Keywords: ischaemic stroke; left MCA territory infarction; right MCA territory infarction; tissue plasminogen activator; thrombolytic therapy

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