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Successful thrombolysis of a wake-up stroke aided by Computed Tomography Perfusion (CTP) imaging: A case report

Authors:

Thilina Rathnasekara,

Teaching Hospital, Anuradhapura, LK
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Manoj Chathuranga,

Teaching Hospital, Anuradhapura, LK
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Koralegedara Dayaratne,

Teaching Hospital, Anuradhapura, LK
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Thushara Muthunayake,

Teaching Hospital, Anuradhapura, LK
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Prasanna Weerawansa,

Rajarata University of Sri Lanka, Saliyapura 50008, LK
About Prasanna
Department of Medicine, Faculty of Medicine and Allied Sciences
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Hemal Senanayake

Rajarata University of Sri Lanka, Saliyapura 50008, LK
About Hemal
Department of Medicine, Faculty of Medicine and Allied Sciences
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Abstract

An 80-year-old man was admitted with aphasia since wakeup. His Computed Tomography Perfusion (CTP) study of the brain revealed a significant but patchy penumbra with a minimal core. His Magnetic Resonance Imaging (MRI) also confirmed a mismatch between Diffusion-weighted MRI (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences (DWI-FLAIR mismatch) supporting the existence of a significant ischaemic penumbra. He underwent thrombolysis with tenecteplase (TNK) after 5 hours and 40 minutes since waken up and had a good recovery with the improvement of the National Institute of Health Stroke Scale (NIHSS) from 5 to 0. Acute stroke patients could benefit from thrombolysis beyond the window period of 4.5 hours if there is a significant penumbra in the CT perfusion imaging and tenecteplase may have an added advantage over alteplase(r-tPA) in such circumstances.
How to Cite: Rathnasekara, T., Chathuranga, M., Dayaratne, K., Muthunayake, T., Weerawansa, P. and Senanayake, H., 2022. Successful thrombolysis of a wake-up stroke aided by Computed Tomography Perfusion (CTP) imaging: A case report. Anuradhapura Medical Journal, 16(1), pp.21–25. DOI: http://doi.org/10.4038/amj.v16i1.7707
Published on 23 Mar 2022.
Peer Reviewed

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