Utilization of DWI-FLAIR Mismatch for Intravenous Thrombolysis in an Elderly Patient With Stroke

Abstract

Objectives

To discuss utility of using DWI-FLAIR mismatch in select patients not included in the original WAKE-UP trial for administration of IV thrombolytics.

Methods

We identified a female over 100 years old who presented with stroke symptoms upon waking up. This case is selected due to its unique management. Relevant clinical data was collected through a review of the patient’s medical records. All data were anonymized to ensure confidentiality.

Results

A 102-year-old female with a complex past medical history of atrial fibrillation, not on anticoagulation presented with a National Institutes of Health Stroke Scale (NIHSS) of 23. Stroke symptoms were present upon awakening. Noncontrast computed tomography (CT) of the head was negative for hemorrhage or early ischemic changes. CT angiography (CTA) of the head and neck was notable for a distal right M2 occlusion. A hyperacute magnetic resonance imaging (MRI) of the brain was pursued to determine potential eligibility for intravenous thrombolysis (IVT). Patient consented to IVT. NIHSS improved to 13. She was eventually discharged to a skilled nursing facility.

Discussion

We aimed to highlight the oldest known case of IV thrombolysis in this patient presenting with a stroke upon awakening. This is to emphasize possible benefit in cases not included in the original WAKE-UP trial.