2018 Volume 40 Issue 2 Pages 86-90
A 68-year-old woman with Fabry disease-associated left ventricular hypertrophy was admitted because of sudden onset left hemiparesis. Her baseline National Institutes of Health Stroke Scale score (NIHSS) was 19. Diffusion-weighted magnetic resonance (MR) imaging of the brain demonstrated hyperintense signals at the right middle cerebral artery (MCA) territory, and Alberta Stroke Program Early CT Score+W (ASPECTS+W) score was 6. MR angiography disclosed the occlusion of the first segment of the right MCA. There was no contraindication to the intravenous application of recombinant tissue-type plasminogen activator (rt-PA) based on the Japanese guidelines for intravenous application of rt-PA edited by guideline committee for intravenous rt-PA in acute ischemic stroke, and we initiated intravenous infusion of rt-PA. The occluded right MCA was successfully recanalized and the patient showed neurological improvement. After hospitalization, paroxysmal atrial fibrillation was detected, and she was diagnosed with cardioembolic stroke. The treatment with intravenous rt-PA may be effective and safe in acute cardioembolic stroke in patients with Fabry disease.
