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Fibrinolysis induced clinical improvement in a patient with multiple sclerosis exacerbation
Konstantin Balashov1, Suhayl Dhib-Jalbut1, Igor Rybinnik1
1Department of Neurology, Rutgers RWJMS, 125 Paterson Street, Suite 6200, New Brunswick, NJ 08901.
Background:
Recently, extravascular fibrinogen leakage has emerged as a potential trigger of local neuroinflammation in the CNS. In the animal models of MS, fibrin depletion decreased neuroinflammation and neurodegeneration. The role of fibrinolytic therapy in patients with MS has not been studied.
Objective:
To describe a unique case of rapid clinical improvement after fibrinolytic therapy in a patient with MS and symptomatic acute demyelinating lesion.
Methods:
The MS patient with acute right-sided weakness was thought to have a stroke and received intravenous recombinant tissue plasminogen activator (rtPA). Serial neurological exams and MRI were performed.
Results/Conclusion:
In 5.4 hours after rtPA administration, NIH Stroke Scale score improved from 9 to 1, and this improvement persisted until 21 hours from symptom onset, approximate duration of rtPA action. Brain MRI revealed a symptomatic acute demyelinating lesion with restricted diffusion. We suggest that fibrin may serve as a potential therapeutic target in a subset of people with MS.
Insights
Fibrinolytic therapy, using recombinant tissue plasminogen activator (rtPA), rapidly improved a patient with multiple sclerosis (MS) and a demyelinating lesion. This suggests fibrin may be a therapeutic target in MS.
Area of Science:
- Neuroscience
- Immunology
- Neurology
Background:
- Extravascular fibrinogen leakage is implicated in central nervous system (CNS) neuroinflammation.
- Fibrin depletion reduced neuroinflammation and neurodegeneration in animal models of multiple sclerosis (MS).
- The therapeutic potential of fibrinolytic therapy in MS patients remains uninvestigated.
Observation:
- A patient with MS presented with acute right-sided weakness, initially suspected as stroke.
- The patient received intravenous recombinant tissue plasminogen activator (rtPA) for suspected stroke.
- Serial neurological examinations and MRI scans were conducted.
Findings:
- The patient experienced rapid clinical improvement within 5.4 hours of rtPA administration, with NIH Stroke Scale score decreasing from 9 to 1.
- This improvement was sustained for approximately 21 hours, coinciding with the duration of rtPA action.
- Brain MRI confirmed a symptomatic acute demyelinating lesion exhibiting restricted diffusion.
Implications:
- Fibrin may represent a potential therapeutic target for a subset of individuals with MS.
- This case highlights a novel application of fibrinolytic therapy in managing acute demyelinating events in MS.
- Further research is warranted to explore the efficacy and safety of fibrinolytic agents in MS treatment.
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