Dados do Trabalho

Título

Thrombolysis in a large unruptured intracranial aneurysm: a case report

RESUMO

CASE PRESENTATION: A 17-year-old patient, with a previous diagnosis of aneurysm in the right middle cerebral artery (4.7x2.4x1.9 cm), presented to our hospital complaining of sudden onset of left sided hemiparesis and hemihypoesthesia (NIHSS 14). On admission, computed tomography hasn’t showed any ischemic parenchymal injury or intracranial bleeding. Computed tomographic angiography has confirmed diffusely irregular aneurysmal dilatation throughout its M1 segment of right middle cerebral artery associated with occlusion of the same vessel and the A1 segment of anterior cerebral artery. He underwent chemical reperfusion therapy with Tenecteplase 0.25mg/kg, with excellent outcome, improving the NIHSS to 5 in a few hours. Arteriography confirmed a dissecting aneurysm of right MCA. Patient has maintained neurological improvement being discharged with NIHSS 3 and an elective evaluation of aneurysm approach. DISCUSSION: The major concern with intravenous thrombolytic therapy is the presence of symptomatic intracranial bleeding. The presence of aneurysmal formation is not an absolute contraindication for thrombolysis, however, due to the increased risk of bleeding, there is a tendency to choose not to proceed with the therapy. FINAL COMMENTS: Most guidelines and studies point to a reasonable safety of thrombolysis in aneurysms < 10 mm, but there is still little information about aneurysms with larger dimensions.

Palavras Chave

Thrombolysis, Aneurysm