Thrombolytic therapy in total mismatch with severe stroke after acute MCA-occlusion and negative DWI

Total mismatch is a recently described magnetic resonance imaging (MRI) pattern in acute stroke patients with no signal changes in diffusion weighted images (DWI) and extensive hypoperfusion on perfusion weighted images (PWI). The prognostic value and importance for treatment decision based on this finding in MRI have recently been controversially discussed in patients with minor stroke . Here we report a case of a 98-year-old woman that presented with severe stroke and total mismatch in the left middle cerebral artery (MCA) territory in MRI scan and an occlusion of the proximal MCA (M1) in time-of flight MR angiography (TOF-MRA). The patient was treated with systemic thrombolysis followed by complete remission of neurological symptoms and remaining negative DWI in post treatment MRI. We discuss the possible pathophysiological background of this phenomena and its impact on tailoring therapeutic strategies in patients with relative contraindications to thrombolytic therapy.
Source: Clinical Neurology and Neurosurgery - Category: Neurosurgery Authors: Tags: Case reports Source Type: research