Intravenous tissue plasminogen activator therapy for an acute ischemic stroke patient with later diagnosed unilateral moyamoya syndrome

Shota Yokoyama, Yasuhiro Manabe, Daiki Fujii, Yasuko Ikeda-Sakai, Hisashi Narai, Nobuhiko Omori, Koji Abe

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

We report the use of intravenous tissue plasminogen activator (t-PA) therapy in a 38-year-old patient who was later diagnosed with unilateral moyamoya syndrome. The patient had a sudden onset of unconsciousness, vomiting, dysarthria, and tetraparesis. A neurologic examination revealed consciousness disturbance, right central facial nerve palsy, dysarthria, and tetraparesis with bilateral exotropia and horizontal gaze palsy. A magnetic resonance imaging scan on admission did not reveal fresh cerebral infarction or hemorrhage, but magnetic resonance angiography revealed severe stenosis at the terminal portion of left internal carotid artery, the anterior cerebral arteries, and the right vertebral artery. We suspected infarction of brain stem. The patient was treated with intravenous t-PA approximately 2.5 hours after onset, and the patient demonstrated a remarkable recovery 1 day after onset and had only a minimal deficit at discharge (12 days after onset). Cerebral angiography 7 days after onset confirmed the diagnosis of moyamoya disease. The present case suggests that therapeutic intravenous t-PA may be applicable for an acute ischemic stroke patient coexisting with moyamoya disease after careful evaluation and discussion with patient and family.

Original languageEnglish
Pages (from-to)1190-1192
Number of pages3
JournalJournal of Stroke and Cerebrovascular Diseases
Volume22
Issue number7
DOIs
Publication statusPublished - Oct 2013

Fingerprint

Moyamoya Disease
Tissue Plasminogen Activator
Stroke
Dysarthria
Therapeutics
Brain Stem Infarctions
Exotropia
Anterior Cerebral Artery
Cerebral Angiography
Unconsciousness
Vertebral Artery
Facial Paralysis
Magnetic Resonance Angiography
Cerebral Infarction
Cerebral Hemorrhage
Facial Nerve
Neurologic Examination
Internal Carotid Artery
Consciousness
Paralysis

Keywords

  • Moyamoya disease
  • tissue plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

Cite this

Intravenous tissue plasminogen activator therapy for an acute ischemic stroke patient with later diagnosed unilateral moyamoya syndrome. / Yokoyama, Shota; Manabe, Yasuhiro; Fujii, Daiki; Ikeda-Sakai, Yasuko; Narai, Hisashi; Omori, Nobuhiko; Abe, Koji.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 7, 10.2013, p. 1190-1192.

Research output: Contribution to journalArticle

Yokoyama, Shota ; Manabe, Yasuhiro ; Fujii, Daiki ; Ikeda-Sakai, Yasuko ; Narai, Hisashi ; Omori, Nobuhiko ; Abe, Koji. / Intravenous tissue plasminogen activator therapy for an acute ischemic stroke patient with later diagnosed unilateral moyamoya syndrome. In: Journal of Stroke and Cerebrovascular Diseases. 2013 ; Vol. 22, No. 7. pp. 1190-1192.
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