When thrombus meets intracranial dissection: a tricky decision for intravenous thrombolysis.
Marialuisa Zedde, Vincenzo D'Agostino, Francesca Romana Pezzella et al.
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Case in brief
A 34-year-old male presented with sudden neurological symptoms. Initial NCCT showed a hyperdense enlargement of the left V4 vertebral artery, and CTA indicated a focal dissection with thrombus. Despite guidelines advising against intravenous thrombolysis (IVT) in such cases, IVT was administered, resulting in rapid clinical improvement and normalization of function within 24 hours. MRI later confirmed the dissection and monitored the mural hematoma's evolution.
Diagnostic / clinical pearl
Clinicians should consider advanced imaging techniques for diagnosing unusual stroke causes, such as intracranial dissection, which may warrant individualized treatment approaches.
Why it matters
This case challenges the strict adherence to guidelines regarding IVT in intracranial dissection, suggesting that clinical judgment and imaging findings may support its use in select cases.