Very Early Short-Course Cerebrolysin After Tenecteplase and Mechanical Thrombectomy: A Case Report

Despite high recanalization rates with mechanical thrombectomy (MT), large-vessel occlusion stroke results in death or dependency in over half of patients. Cerebrolysin, a multimodal neuropeptide preparation, may attenuate ischemia-reperfusion injury and support early neurorehabilitation. We report a 88-year-old woman with moderate prestroke disability who presented 2 h after the onset of right hemiparesis and aphasia due to M2 occlusion of the left middle cerebral artery. She received intravenous tenecteplase followed by MT, achieving complete reperfusion after three passes with no direct complications and no immediate clinical improvement. Directly postprocedure, cerebrolysin 30 mL/day was initiated as adjunctive treatment. Over the next 24 h, neurological deficits gradually resolved with no hemorrhagic transformation or evident infarct on follow-up CT. As the patient did not require early intensive rehabilitation and regained her prestroke functional status, cerebrolysin was discontinued after three doses. This report is not intended to establish the therapeutic efficacy of short-course adjunctive cerebrolysin. It illustrates how clinical signals from randomized and observational studies can be interpreted for the purpose of individual therapeutic decisions.