A 93-year-old female patient with a history of chronic arterial hypertension, definitive user due to sinus node disease, hypothyroidism and colon cancer operated in her youth.
She lives alone, completely autonomous, without cognitive impairment.
On the day of admission he suddenly presented a motor defect in the right hemibody.
It was brought by relatives before an hour of evolution to the Clinical Hospital of the University of Chile (HCUCh).
Neurological examination revealed a patient alert, oriented, dysarthric, with left hemine-gland predominance, ipsilateral hemi-arm discomfort and left hemiparesis, right-sided conjugated gaze deviation, hypoplegia.
The neurological deficit estimated at admission using the National Institute of Health Stroke Scale (NIHSS) was 14 points (where a score of 0 accounts for a normal neurological examination, while a tetrapon score of 42 represents a normal neurological examination).
Computed tomography of the brain (CT) showed early signs of cerebral ischemia at the right lenticular level, with loss of differentiation of the right lenticulum-artery (CA) boundary suggestive of a thrombus in the proximal segmentM
The patient was admitted to the Cerebrovascular Attack Treatment Unit of HCUCh, following the established protocol for the management of these patients in our hospital.
1.
In the absence of contraindications for intravenous thrombolytic therapy, thrombolysis with t-PA was performed 2 h after the onset of stroke symptoms, the remaining 90% according to the guidelines specified in the NINDS4 protocol neurological examination and a 10% improvement
The control CT at 24 h showed a consolidated infarction not lacunar only in the right lenticular region, without evidence of ischemic damage in the rest of the territory irrigated by the MCA.
No hemorrhagic complications were observed.
1.
The etiological study showed severe dilation of the left atrium, with spontaneous contrast inside.
This, in addition to the history of sinus node disease and in the absence of other etiological sources, a cardioembolic phenomenon was proposed as the probable cause of stroke, so oral heparinoc began with anticoagulant treatment.
There were no systemic complications of any kind during hospitalization.
The patient improved progressively, with a 3-point NIHSS score at discharge.
After three months, the patient was completely autonomous, with a modified Rankin scale score of 1 point, with minimal changes on neurological examination and a NIHSS score of 0 point.
