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Updated: May 23, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

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Published on: November 26, 2013

Hemiplegia and thrombolysis.

A Meretoja1, D Strbian, J Putaala

  • 1Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. atte.meretoja@fimnet.fi

European Journal of Neurology
|April 24, 2012
PubMed
Summary

Hemiplegia at stroke onset does not contraindicate thrombolytic therapy with alteplase (tPA). Many patients regain limb movement, with two-fifths achieving independent walking within three months.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Emergency Medicine

Background:

  • Hemiplegia at stroke onset is often considered a contraindication for thrombolytic therapy.
  • Intravenous alteplase (tPA) is a common thrombolytic agent for acute ischemic stroke.

Purpose of the Study:

  • To describe the outcomes of ischemic stroke patients presenting with hemiplegia and treated with intravenous tPA.
  • To evaluate if hemiplegia should preclude thrombolytic therapy.

Main Methods:

  • Prospective recording of patients treated with tPA for acute ischemic stroke (1995-2010) in the Helsinki Stroke Thrombolysis Registry.
  • Exclusion of patients with basilar artery occlusion (BAO).
  • Definition of hemiplegia as no voluntary movement in the ipsilateral arm and leg.

Main Results:

  • Of 1427 eligible patients, 81 (6%) had hemiplegia at baseline.
  • By 3 months, 23% had a good outcome (mRS 0-2), 16% achieved independent ambulation (mRS 3), and 20% died.
  • Advanced age, greater neurological deficit, and early radiological signs correlated with poorer prognosis.
  • Patients with combined fixed eye deviation had worse outcomes and higher rates of fatal intracerebral hemorrhage.

Conclusions:

  • Hemiplegia at presentation should not be an absolute contraindication for thrombolytic therapy.
  • Limb movements often return, and a significant proportion of patients achieve independent walking.
  • Combined fixed eye deviation indicates a poorer prognosis and increased risk of hemorrhagic complications.