Multimodal computed tomography evaluation before thrombolysis in acute ischaemic stroke

Thomas W Leung, Wynnie WM Lam, Simon CH Yu, Cecilia SF Leung, Yannie OY Soo, Lawrence KS Wong
Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong

Currently, when stroke patients are offered thrombolytic therapy, their ischaemic stroke subtypes are usually unknown. Given the risk of haemorrhage that accompanies thrombolytic therapy, unselective (or undiscriminating) use of recombinant tissue plasminogen activator in patients without large-artery thromboemboli is potentially hazardous. Advances in computed tomography techniques have enabled the stroke pathophysiology to be quickly delineated by multimodal computed tomography without compromise in time for recombinant tissue plasminogen activator administration. Through description of the investigation of a typical stroke patient, we report how this technique is feasible in a regional hospital and may guide judicious use of recombinant tissue plasminogen activator.

Hong Kong Med J 2008;14:236-9

Key words: Cerebral hemorrhage; Thrombolytic therapy; Tissue plasminogen activator; Tomography, X-ray computed