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Williams A, Sittampalam M, Barua N, et al. Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke. Cardiovasc Psychiatry Neurol. 2011;2011:254569doi: 10.1155/2011/254569.
Williams, A., Sittampalam, M., Barua, N., & Mohd Nor, A. (2011). Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke. Cardiovascular psychiatry and neurology, 2011254569. https://doi.org/10.1155/2011/254569
Williams, A, et al. "Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke." Cardiovascular psychiatry and neurology vol. 2011 (2011): 254569. doi: https://doi.org/10.1155/2011/254569
Williams A, Sittampalam M, Barua N, Mohd Nor A. Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke. Cardiovasc Psychiatry Neurol. 2011;2011:254569. doi: 10.1155/2011/254569. Epub 2011 Apr 18. PMID: 21541210; PMCID: PMC3085311.
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Cardiovasc Psychiatry Neurol. 2011;2011:254569. doi: 10.1155/2011/254569. Epub 2011 Apr 18.

Case series of post-thrombolysis patients undergoing hemicraniectomy for malignant anterior circulation ischaemic stroke.

Cardiovascular psychiatry and neurology

A Williams, M Sittampalam, N Barua, A Mohd Nor

Affiliations

  1. Department of Neurosurgery, Derriford Hospital, Plymouth, PL6 8DH, UK.

PMID: 21541210 PMCID: PMC3085311 DOI: 10.1155/2011/254569

Abstract

While ischaemic stroke remains a leading cause of death and disability, there have been recent advancements in treatment modalities including thrombolysis and decompressive hemicraniectomy. A retrospective review of patients treated in our NHS teaching hospital, in Plymouth (UK), over a 2 year period identified 17 thrombolysed patients, of whom two had undergone subsequent decompressive hemicraniectomy. These were non-dominant hemisphere strokes in young patients, aged 51 and 57. Initial NIHSS scores were 16 and 17, and they received thrombolysis at 2 hrs 42 min and 5 hrs 10 min post onset of symptoms respectively. CT imaging demonstrated cerebral swelling with significant midline shift in both cases, and decompressive hemicraniectomy was undertaken at 29 hrs 8 min and 27 hrs 30 min post-thrombolysis. We found no significant intra-operative complications attributable to prior use of thrombolytics. Both patients have had acceptable psychological and physical outcomes, with Barthel Index scores of 40 and 25, and MMSE scores of 29/30 and 27/30. We conclude that the use of thrombolytic therapy does not contra-indicate subsequent decompressive hemicraniectomy in well selected patients with non-dominant hemisphere strokes. More research in this field is required to elucidate factors which would facilitate recognition of stroke patients who will benefit most from aggressive medical and neurosurgical intervention.

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