Treating acute ischemic stroke in a patient with multiple sclerosis: a challenging issue

Publication date: Available online 23 January 2020Source: Multiple Sclerosis and Related DisordersAuthor(s): Arturo de Falco, Marta De Simone, Florindo d'Onofrio, Daniele Spitaleri, Fabrizio Antonio de FalcoAbstractMultiple sclerosis (MS) is a chronic disease characterized by inflammation, demyelination and neurodegeneration in the central nervous system. Recent studies suggested that patients with MS might have a greater risk of ischaemic stroke (IS). IS treatment with intravenous alteplase (IVA) in MS has rarely been reported. This could be due to the challenging diagnosis between acute IS and MS relapse, considering that clinical and neuroradiological findings might overlap. Here we report a 47-year-old man with a 6-year history of relapsing-remitting MS who presented to the emergency room for acute left limbs weakness and hypoesthesia diagnosed as ischemic stroke after advanced MRI imaging. Patient was treated with IVA and treatment was complicated by a parenchymal hematoma (PH) despite low risks due to young age, the young age, low NIHSS score, small ischemic lesion and absence of multiple vascular risk factors. We discuss the possible relationship between MS and IS and the use of IVA in MS patients and finally we consider the possible causes of the PH including the MS disease-modifying therapies.
Source: Multiple Sclerosis and Related Disorders - Category: Neurology Source Type: research