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(Stroke. 2005;36:e162.)
© 2005 American Heart Association, Inc.

Case Report

Thrombolysis Beyond the Guidelines

Two Treatments in One Subject Within 90 Hours Based on a Modified Magnetic Resonance Imaging Brain Clock Concept

Raffi Topakian, MD; Franz Gruber, MD; Franz A. Fellner, MD; Hans-Peter Haring, MD Franz T. Aichner, MD

From the Departments of Neurology (R.T., F.G., H.-P.H., F.T.A.) and Radiology (F.A.F.), Hospital Wagner-Jauregg Linz, Austria.

Correspondence to Raffi Topakian, MD, Department of Neurology, Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, 4020 Linz, Austria. E-mail raffi.topakian{at}aon.at

Background and Purpose— We report the first case of 2 intravenous thrombolysis treatments within 90 hours in a patient with early recurrent stroke.

Summary of Review— A 50-year-old man had improved significantly after intravenous thrombolysis for acute stroke. On the fourth day, he deteriorated dramatically because of recurrent stroke. Evidence of vessel reocclusion and profound perfusion/diffusion mismatch constituted the rationale for a second thrombolysis treatment, which resulted in vessel recanalization and significant neurologic improvement.

Conclusion— The pathophysiological information obtained by multimodal magnetic resonance imaging may suit as a brain clock when repeat thrombolysis treatment is considered for early recurrent stroke.

Key Words: magnetic resonance imaging • stroke • thrombolysis

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