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Treating acute ischemic stroke in a patient with multiple sclerosis: A challenging issue
Arturo de Falco1, Marta De Simone2, Florindo d'Onofrio1
1Neurology and Stroke Unit, Azienda Ospedaliera San G. Moscati, Contrada Amoretta, Avellino 83100, Italy.
Multiple Sclerosis and Related Disorders
|February 5, 2020
Summary
Multiple sclerosis patients may face increased ischemic stroke risk. Intravenous alteplase treatment in MS patients, though rarely reported, can lead to complications like parenchymal hematoma.
Area of Science:
- Neurology
- Neuroimmunology
- Vascular Neurology
Background:
- Multiple sclerosis (MS) is a chronic central nervous system inflammatory, demyelinating, and neurodegenerative disease.
- Emerging evidence suggests an elevated risk of ischemic stroke (IS) in patients with MS.
- Treatment of IS with intravenous alteplase (IVA) in MS patients is infrequently documented due to diagnostic challenges.
Observation:
- A 47-year-old male with a 6-year history of relapsing-remitting MS presented with acute left limb weakness and hypoesthesia.
- Advanced MRI confirmed a diagnosis of ischemic stroke, distinct from an MS relapse.
- The patient received intravenous alteplase (IVA) for the ischemic stroke.
Findings:
- Despite a low-risk profile (young age, low NIHSS, small lesion, no vascular risk factors), IVA treatment resulted in a parenchymal hematoma (PH).
- This case highlights a potential complication of IVA in MS patients.
Implications:
- The study discusses the potential link between MS and IS, and the cautious use of IVA in this population.
- It explores potential causes for the parenchymal hematoma, including MS disease-modifying therapies.
- Further research is needed to understand IS risk and optimize IVA treatment protocols in MS patients.
