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Issue: Issue 5 (2018) – Supplement 2

Oral Presentation

The penumbra of fleeting neurological symptoms: a case of thrombectomy over 6 hours after symptom onset

Margarida Bela, Ana Sardoeira, Carlos Andrade, and José Pedro Rocha Pereira
Introduction: Short-term episodes of neurological dysfunction resulting from focal cerebral ischemia are classically defined as transient ischemic attacks (TIA), while a new infarct on imaging defines stroke. Plain head CT is still the modality of choice in the hyper-acute phase, while advanced imaging - CT-angiography and CT-perfusion - are performed in select centres. We report a case of stroke which highlights the usefulness of advanced imaging. 
Case Report: A 69-year-old woman with hypertension, dyslipidaemia and colic adenocarcinoma in remission presented at another institution complaining of dysarthria and left hemiparesis, which had lasted for 2 hours. Upon evaluation, her neurological exam was reportedly normal, and the brain CT was unremarkable. She was discharged after 12 hours of surveillance without symptom recurrence. Eight hours later, symptoms recurred; she scored 5 on the NIHSS due to dysarthria, hemihypesthesia and left hemiparesis (G4/5). CT-angiography showed a right M2 occlusion and she was transferred for mechanical thrombectomy. Repeat CT ASPECTS was 10. CT-perfusion showed no ischaemic core and a hypoperfused area, centred in the Rolandic region, corresponding to an area of ischaemic penumbra. Mechanical thrombectomy was performed 9 hours after symptom onset. She scored 0 on the NIHSS 24h after the procedure, and the inpatient follow-up was uneventful. No definite stroke aetiology was found, despite comprehensive investigation. 
Conclusion: This case illustrates the TIA-stroke continuum and the importance of early advanced imaging in the setting of the recently published stroke guidelines.

From the Porto University Center of Medicine Stroke Update Course, Porto, Portugal. 26–27 June 2018.

International Journal of Clinical Neurosciences and Mental Health 2018; 5(Suppl. 2):O26
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