Case Report

Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report

Volume: 3 Number: 1 January 31, 2025
EN TR

Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report

Abstract

Intravenous tissue plasminogen activator (IV tPA) is a proven treatment method for acute ischemic stroke. In this report, we share a case where IV tPA treatment was administered during the 6th week of pregnancy due to acute ischemic stroke, and there were no problems in the mother and baby during long-term follow-up. Here, we present a 32-year-old female patient, in the 6th week of her pregnancy, presented to our emergency department at the 47th minute of the onset of symptoms. National Institute of Health Stroke Scale (NIHSS) score was 10. On diffusion-weighted magnetic resonance imaging (MRI), an infarction was observed in the right middle cerebral artery, and on cranial MR angiography, a thrombus was detected at the level of the right middle cerebral artery M2-3. Thrombolytic therapy was initiated 90 minutes after the onset of the first symptoms. No maternal or fetal problems were detected. The patient had a Modified Rankin Score of 0 at 3 months. We administered IV tPA treatment to the pregnant patient who presented with severe stroke symptoms considering the benefits outweighed the risks.

Keywords

First trimester, pregnancy, thrombolytic therapy

References

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APA
Haki, C., Ay, B. N., Evren, A., & Kamisli, S. (2025). Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report. Journal of Bursa Faculty of Medicine, 3(1), 8-12. https://doi.org/10.61678/bursamed.1537262
AMA
1.Haki C, Ay BN, Evren A, Kamisli S. Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report. J Bursa Med. 2025;3(1):8-12. doi:10.61678/bursamed.1537262
Chicago
Haki, Cemile, Beyza Nur Ay, Ayfer Evren, and Suat Kamisli. 2025. “Thrombolytic Therapy in Acute Ischemic Stroke During Pregnancy: A Case Report”. Journal of Bursa Faculty of Medicine 3 (1): 8-12. https://doi.org/10.61678/bursamed.1537262.
EndNote
Haki C, Ay BN, Evren A, Kamisli S (January 1, 2025) Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report. Journal of Bursa Faculty of Medicine 3 1 8–12.
IEEE
[1]C. Haki, B. N. Ay, A. Evren, and S. Kamisli, “Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report”, J Bursa Med, vol. 3, no. 1, pp. 8–12, Jan. 2025, doi: 10.61678/bursamed.1537262.
ISNAD
Haki, Cemile - Ay, Beyza Nur - Evren, Ayfer - Kamisli, Suat. “Thrombolytic Therapy in Acute Ischemic Stroke During Pregnancy: A Case Report”. Journal of Bursa Faculty of Medicine 3/1 (January 1, 2025): 8-12. https://doi.org/10.61678/bursamed.1537262.
JAMA
1.Haki C, Ay BN, Evren A, Kamisli S. Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report. J Bursa Med. 2025;3:8–12.
MLA
Haki, Cemile, et al. “Thrombolytic Therapy in Acute Ischemic Stroke During Pregnancy: A Case Report”. Journal of Bursa Faculty of Medicine, vol. 3, no. 1, Jan. 2025, pp. 8-12, doi:10.61678/bursamed.1537262.
Vancouver
1.Cemile Haki, Beyza Nur Ay, Ayfer Evren, Suat Kamisli. Thrombolytic therapy in acute ischemic stroke during pregnancy: A case report. J Bursa Med. 2025 Jan. 1;3(1):8-12. doi:10.61678/bursamed.1537262