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Título

STROKE MIMIC THROMBOLYSIS IN A PATIENT WITH PARTIAL ABDOMINAL ANEURYSM THROMBOSIS

RESUMO

CASE PRESENTATION: MGFM, 73 years old, female, with normal pressure hydrocephalus (NPH) using a ventriculoperitoneal shunt (PVD), was admitted to the hospital due to spontaneous exteriorization of an abdominal catheter. During the investigation, a partially thrombosed fusiform aneurysm was observed in the infrarenal segment of the abdominal aorta, with an extension of 10 cm and a diameter of 8.0x6.2 cm, with characteristics of instability. Indicated aortic endoprosthesis. While waiting for the procedure, the patient developed vomiting and sudden aphasia, presenting a score of 11 on the National Institutes of Health Stroke Scale (NIHSS). Cranial tomography presented an ASPECTS of 10. Intravenous chemical thrombolysis with alteplase was performed, the post-procedure NIHSS score was 8, with no other complications. Ultrasound study of the cervical arteries and echocardiogram were normal. Magnetic Resonance Imaging of the Skull did not show an area of previous ischemia, configuring, therefore, a mimic stroke of a patient with hydrocephalus of undetermined origin. The patient was discharged with a NIHSS of 2. Three months later, the endoprosthesis implantation surgery was successfully performed. DISCUSSION: Intravenous thrombolysis is associated with an increased risk of intracranial aneurysm rupture, resulting in intracranial hemorrhage. The 2018 American Heart Association (AHA) guidelines suggest that thrombolysis is safe in unruptured intracranial aneurysms less than 10 mm in diameter. There is no recommendation regarding extracranial aneurysms. Experience with endovascular thrombectomy in patients with thrombosed intracranial aneurysms causing acute stroke is also limited. Proposed mechanisms of stroke related to unruptured aneurysms include thrombosis with distal embolization, extension of the thrombosis to the parent artery, or compression of the parent artery by the aneurysm. The risk of symptomatic intracranial hemorrhage in people with stroke mimic is low. FINAL COMMENTS: It is unclear whether thrombolysis is safe in extracranial aneurysm cases, future case series may be useful to answer the question. Furthermore, in cases of ischemic stroke within the therapeutic window, intravenous thrombolysis should be performed, except in known contraindications, because even in cases of stroke mimics the risk of intracranial bleeding is low.

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KEYWORDS: stroke-mimic, thrombolysis, aneurysm