London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 371 167 Interesting and challenging cases Successful repeat IV thrombolysis (r-tPA) within 6 hours N.M. Lobo1, F Chaudery2, F Gergely3, T Webb4, I Balogun5, D Hargroves6 William Harvey Hospital, Ashford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM1, William Harvey Hospital, Ashford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM2, William Harvey Hos-pital, Ashford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM3, William Harvey Hospital, Ash-ford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM4, William Harvey Hospital, Ashford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM5, William Harvey Hospital, Ashford, Kent, TN24 0LZ, Ashford, UNITED KINGDOM65 Intravenous r-tPA has poor rates of persistent recanalisation in large vessel occlusive acute isch-aemic stroke, with only a minority of centres worldwide offering 24 hour primary or rescue intra-ar-terial therapy. The evidence for repeat IV thrombolysis in recurrent large vessel stroke is limited. We describe the case of a patient successfully receiving two IV r-tPA treatments within 6 hours. An 82 year old male presented with left-sided weakness, facial droop and dysarthria (NIHSS 17). CTA demonstrated occlusion of the M2 segment of right MCA. He was thrombolysed with 83mg IV r-tPA 44 minutes from symptom onset. NIHSS was 0 at one hour post-thrombolysis. 5 hours later he deteriorated, developing similar right MCA symptoms with a repeat NIHSS of 17. CT confirmed re occlusion of M2. Further IV r-tPA was given a second time followed by a heparin infusion. Al-though there was no improvement in NIHSS 24 hours post-thrombolysis, NIHSS at 48 hours was 12. No signs of intracerebral haemorrhage were observed after either treatment. Repeat IV thrombolysis is relatively contraindicated due to the increased risk of intracerebral hae-morrhage, especially in infarcted areas. However, this case report demonstrates that repeat IV r-tPA may be tolerated in some patients with short symptom to needle times if access to intra-arterial ther-apy is unavailable. Open access to intra-arterial therapy and studies to establish the safety and effi-cacy of repeat IV thrombolysis in early stroke recurrence are required. 168 Interesting and challenging cases An unusual case of acute stroke associated retroperitoneal infection and abscess: a dangerous complication Z. Shi1, J. QU2, X. FANG3 Dongguan people’s hospital, Dongguan, CHINA1, Dongguan people’s hospital, Dongguan, CHI-NA2, Dongguan people’s hospital, Dongguan, CHINA3 Background Although stroke associated infections have been well addressed , it is still a challenging problem concerning clinical practice. Method We report the clinical and radiological findings in a unusual case of acute ischemic stroke patient with severe retroperitoneal infection, which evolved into an abdominal balloon-like abscess. A 74 year old female was found unresponsive with drooling mouth and left sided paralysis in the morning by her families. She was brought to local clinic and diagnosed as an acute ischemic stroke after CT scan. For the next ten days her condition deteriorated with a fever of 38.6℃. She was transferred to our hospital. MRI revealed a RICA occlusion and we started antibiotics therapy for the stroke associated pneumonia. Although her chest X-ray suggested a good response and she regained conscious during the first week, she was still running a fever with unknown origin. On the 7th day she presented with melena and a soft mass was palpated on the left side of abdomen. The following abdominal X-ray indicated an increasing balloon-like cavity and diagnostic abdominocentesis result showed concord with it and manifested a positive pressure. The abdominal CT scan with enhancement revealed a retroperitoneal infection with an abdominal bal-loon- like abscess .Simultaneously feces-like substance seeped from the abdominocentesis puncture faucet. Result On reviewing her relatives, we learnt that the patient was first found lying on her left side because of her left hemiplegia and there once occurred a pressure ulcer on the left abdomen. This kind of long term passive posture seemed have caused necrosis of the descending colon which subsequently induced fecal leakage and resulted in severely retroperitoneal infection with an ab-dominal balloon-like abscess. Conclusion Despite the well known pulmonary and urinal origin of post stroke infection, attention must be paid for those unusual infection with unknown origin. To our knowledge, it is the first report of stroke associated retroperitoneal infection, which was a dangerous complication of stroke.
Karger_ESC London_2013
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