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Embolic stroke following thrombolytic therapy for myocardial infarction in a patient with preexisting ventricular
1Department of Neurology, Washington University, St Louis, Mo.
Insights
Thrombolytic therapy for myocardial infarction may dislodge cardiac thrombi, potentially causing embolic strokes. Further research is needed to evaluate this risk in patients with pre-existing ventricular thrombi.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Pre-existing cardiac thrombi are a potential, though unconfirmed, cause of embolic strokes following thrombolytic therapy for myocardial infarction.
- Thrombolytic agents are crucial in managing myocardial infarction but carry risks.
Observation:
- An 82-year-old woman with congestive heart failure and ventricular thrombi received streptokinase for myocardial infarction.
- Post-treatment, she experienced a sudden global aphasia and right hemiparesis, indicative of a stroke.
- Echocardiography post-stroke revealed no thrombus, suggesting embolization.
Findings:
- The case suggests that thrombolytic therapy may have caused embolization of pre-existing ventricular thrombi.
- The patient's stroke symptoms resolved after the presumed thrombus dislodged.
Implications:
- Cardiac conditions predisposing to embolic strokes may not be absolute contraindications to thrombolytic therapy.
- The potential for thrombolytic therapy to induce embolization in patients with cardiac mural thrombi requires further investigation.
- This case highlights the importance of considering thrombus embolization as a complication of thrombolytic therapy.
Background:
Dislodging of preexisting cardiac thrombi has been a reported but unconfirmed cause of embolic strokes after thrombolytic therapy for myocardial infarction.
Case Description:
An 82-year-old woman was admitted with congestive heart failure. Initial echocardiogram demonstrated ventricular thrombi. Three days later she experienced an inferior wall myocardial infarction, and intravenous streptokinase was administered. Six hours later she abruptly developed a global aphasia with a dense right hemiparesis. Repeat echocardiogram did not show any thrombus.
Conclusions:
Thrombolytic therapy may have caused embolization of ventricular thrombi. Cardiac conditions that predispose to embolic strokes are not established contraindications to thrombolytic therapy. The potential for thrombolytic therapy to produce embolization in patients with preexisting cardiac mural thrombi should be evaluated.