When Task is Huge but Time is Short! An Interesting Case of Stroke Thrombolysis

A 64-year-old gentleman, diabetic, and smoker attended the emergency room (ER) with acute stroke. He had expressive aphasia with right upper limb weakness. His blood pressure was extremely high, and he presented in the final half an hour of the permissible window period for thrombolysis. Bringing down his blood pressure to make him eligible for the procedure within the available time was a real challenge for us. Fortunately, we succeeded in our attempt and he gradually improved. Truly, the maximum blood pressure allowable in his case to make him still eligible for thrombolysis was not clear to us. He had an explainable intracranial arterial stenosis and was probably auto-regulating during his acute presentation. Hence, we could have been more lenient in bringing down his blood pressure and thrombolyzed him earlier. A modified guideline will help us to handle these special situations more confidently and allow more patients to get the benefit of thrombolysis.