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A 55-year-old gentleman was admitted to Sharda Hospital with sudden an onset of slurring of speech. There was no significant deficit in power and he was otherwise neurologically preserved. After running the initial tests a CT Scan of the brain was conducted which came out to be absolutely normal. In view of the persistent symptoms, an MRI was scheduled, whose results suggested multiple discrete small lesions in bilateral centrum semiovale, the left capsuloganglionic region and the left parietal lesion. All these results pointed towards an infarct which could occur due to inadequate blood supply to the affected area.
The patient was initiated on anti-platelets and statins and other supportive care which resulted in improvement in his condition. Three days later, however, the patient developed sudden onset of hemiplegia of the right side with Broca's aphasia and was urgently taken up for another MRI The results of the MRI showed a larger infarct involving left front-parietal infarct and left basal ganglia infarct. The MRA (ToF) also showed non-visualization of left ICA infarct with attenuation of the M2 segment of left MCA infarct.
Keeping all this in mind, an opinion was taken from the neurointerventionalist who suggested that a thrombectomy may not be feasible for the patient in view of complete occlusion of ICA.
The patient was therefore offered thrombolysis and written consent was taken.
The patient returned to the power of 4/5 at the end of the thrombolysis and was thereafter taken up for physiotherapy due to which he could walk home at the time of discharge.
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