Abstract
A 17-year-old woman was admitted to our hospital with acute right hemiplegia. At first examination, the patient showed moderate dysarthria and hemiplegia. MR diffusion-weighted imaging showed high intensity at the left basal ganglia, and MRA showed occlusion of left middle cerebral artery at the M1 position. We administered alteplase intravenously within 3 hours after the onset. The patient's NIHSS improved from 12 to 0 within 120 minutes after administration. An artrial septal defect (ASD) was detected using transesophageal echocardiography, and she underwent ASD closure via a thoractomy one month after the onset. She recovered to have mild weakness of the right limbs and returned back to her school life. Although there is no consensus concerning intravenous rt-PA therapy for juvenile ischemic strokes, rapid MR examination should be performed to rule out brain infarction when a juvenile patient without a previous medical history shows a rapid onset of hemiplegia, and we should take it as an indication for thrombolytic therapy.
