CASE REPORT

Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report

Dodik Tugasworo , Aditya Kurnianto, Retnaningsih Retnaningsih, Yovita Andhitara, Rahmi Ardhini, Runy Dyaksani, Jethro Budiman

Dodik Tugasworo
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia. Email: dodiktugasworo2020@gmail.com

Aditya Kurnianto
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Retnaningsih Retnaningsih
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Yovita Andhitara
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Rahmi Ardhini
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Runy Dyaksani
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

Jethro Budiman
Department of Neurology, Dr. Kariadi Hospital/Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
Online First: December 01, 2020 | Cite this Article
Tugasworo, D., Kurnianto, A., Retnaningsih, R., Andhitara, Y., Ardhini, R., Dyaksani, R., Budiman, J. 2020. Recombinant tissue plasminogen activator (rTPA) in young adult patient with acute ischemic stroke: a case report. Bali Medical Journal 9(3): 863-867. DOI:10.15562/bmj.v9i3.2148


Background: Stroke is one of the highest causes of morbidity and mortality in the world. The incidence rate of ischemic stroke is about 80% of all stroke incidents. The use of recombinant tissue plasminogen activator (rtPA) is recommended under 4.5 hours of stroke onset. Stroke in young adults are reported as being uncommon, compromising 10% -15% of all stroke patients. Many studies were reported the most common risk factor in young adults were obesity and dyslipidemia. This case report will discuss a 33-year-old men with ischemic stroke with obesity and dyslipidemia treated at dr. Kariadi Hospital Semarang.

Case presentation: A 33-year old obese man with left-sided hemiparesis and central facial nerve palsy with an onset of 1 hour. On laboratory examination, it was obtained total cholesterol 179mg/dL, LDL level 123mg/dL, and HDL level 39mg/dL. The protocol code stroke was performed in emergency room with alteplase (r-TPA) 0.6 mg/kgBW, after his head MSCT shows there was no sign of blood in the brain parenchym.

Conclusion: The increased risk of ischemic stroke in young patients is due to dyslipidemia, hypertension, obesity, physical inactivity, and smoking. Treatment of the hyperacute phase of ischemic stroke with thrombolysis can reduce the outcome of stroke due to the disability.

References

Putaala J. Ischemic Stroke in Young Adults. Continuum (Minneap Minn). 2020;26(2):386–414.

Jayaraj RL, Azimullah S, Beiram R, Jalal FY, Rosenberg GA. Neuroinflammation: friend and foe for ischemic stroke. J Neuroinflamm. 2019;16(1):1–24.

Bhatt N, Malik AM, Chaturvedi S. Stroke in young adults five new things. Neurol C. 2018;8(6):501–6.

Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018;1–10.

Katan M, Luft A. Global burden of stroke. Semin Neurol. 2018;38:208–11.

Smajlović D. Strokes in young adults: Epidemiology and prevention. Vasc Heal Risk Manag. 2015;11:157–64.

Mehndiratta MM, Mehndiratta P. Stroke in the Young: Newer Concepts in Etiopathogenesis and Risk Factors. Astrocyte. 2018;5(1):26–32.

Putaala J. Ischemic stroke in the young: Current perspectives on incidence, risk factors, and cardiovascular prognosis. Eur Stroke J. 2016;1(1):28–40.

Hervella P, Rodríguez-Castro E, Rodríguez-Yáñez M, Arias S, Santamaría-Cadavid M, López-Dequidt I, et al. Intra- and extra-hospital improvement in ischemic stroke patients: influence of reperfusion therapy and molecular mechanisms. Sci Rep. 2020;10(1):1–11.

Vidale S, Consoli A, Arnaboldi M, Consoli D. Postischemic inflammation in acute stroke. J Clin Neurol. 2017;13(1):1–9.

Yu Y, Han Q, Ding X, Chen Q, Ye K, Zhang S, et al. Defining Core and Penumbra in Ischemic Stroke: A Voxel- and Volume-Based Analysis of Whole Brain CT Perfusion. Sci Rep. 2016;6(1):1–7.

Gainey J, Blum B, Bowie B, Cooley K, Madeline L, Ervin EL, et al. Stroke and dyslipidemia: Clinical risk factors in the telestroke versus non-telestroke. Lipids Heal Dis. 2018;17(1):1–10.

Oesch L, Tatlisumak T, Arnold M, Sarikaya H. Obesity paradox in stroke - Myth or reality? A systematic review. PLoS One. 2017;12(3):1–13.

Wang H, Si Q, Shan Z, Guo Y, Lin K. Effects of Body Mass Index on Risks for Ischemic Stroke, Thromboembolism, and Mortality in Chinese Atrial Fibrillation Patients: A Single-Center Experience. PLoS One. 2015;1–12.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46–110.

Anderson CS, Robinson T, Lindley RI, Arima H, Lavados PM, Lee TH, et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. N Eng J Med. 2016;374(24):2313–23.

Ekker MS, Boot EM, Singhal AB, Tan KS, Debette S, Tuladhar AM, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790–801.

Boot E, Ekker MS, Putaala J, Kittner S, De Leeuw FE, Tuladhar AM. Ischaemic stroke in young adults: A global perspective. J Neurol Neurosurg Ps. 2020;91(4):411–7.

Bhaskar S, Stanwell P, Cordato D, Attia J, Levi C. Reperfusion therapy in acute ischemic stroke: Dawn of a new era? BMC Neurol. 2018;18(1):1–26.

Wouters A, Nysten C, Thijs V, Lemmens R. Prediction of outcome in patients with acute ischemic stroke based on initial severity and improvement in the first 24 h. Front Neurol. 2018;9:1–6.

Abdul-Rahim AH, Fulton RL, Sucharew H, Kleindorfer D, Khatri P, Broderick JP, et al. National institutes of health stroke scale item profiles as predictor of patient outcome: External validation on independent trial data. Stroke. 2015;46(2):395–400.

Menet R, Bernard M, ElAli A. Hyperlipidemia in stroke pathobiology and therapy: Insights and perspectives. Front Physiol. 2018;9:1–6.

Bringeland GH, Nacu A, Waje-Andreassen U, Thomassen L, Naess H. U-curve relation between cholesterol and prior ischemic stroke. Brain Behav. 2016;6(11):1–5.

Seo W-K, Hosseini MB, Bang OY, Liebeskind DS. Recent updates in dyslipidemia management: perspectives in stroke-specific situation. Precis Futur Med. 2020;4(1):9–20.

Campbell BCV, De Silva DA, Macleod MR, Coutts SB, Schwamm LH, Davis SM, et al. Ischaemic stroke. Nat Rev. 2019;5(1):1–22.

Baran J, Mazur A. Association Between Body Mass Index and Results of Rehabilitation in Patients After Stroke: A 3-Month Observational Follow-Up Study. Med Sci Monit. 2019;25:4869–76.

Park H, Lee HW, Yoo J, Lee HS, Nam HS. Body Mass Index and Prognosis in Ischemic Stroke Patients With Type 2 Diabetes Mellitus. Front Neurol. 2019;10:1–8.


No Supplementary Material available for this article.
Article Views      : 0
PDF Downloads : 0