A patient with a middle cerebral artery embolism and widespread early CT signs who recovered almost completely following superselective thrombolytic therapy

Abstract

The widespread appearance of early CT signs is a contraindication for thrombolytic therapy. Here, we report a patient with an ischemic cerebral vascular disorder and widespread early CT signs as a result of an embolism in the middle cerebral artery (MCA) trunk. Superselective thrombolytic therapy with urokinase improved the symptoms without causing the formation of sequelae. A 20-year-old woman developed left semiparalysis after suddenly falling at a bank. Widespread early CT signs were observed on brain CT scans obtained 1 hour after onset. MRI revealed an embolism in the right MCA (M2). Superselective thrombolytic therapy was started 2 hours after onset, and complete re-canalization was achieved within 3 hours of the thrombolytic therapy. The patient recovered almost completely, with only a slight persisting numbness in her left hand.