29/10/2025
/ /Dealys/Hopes
Today is
As we know GOLDEN PERIOD of treatment for ACUTE ISCHEMIC STROKE is 4 hours 30 minutes after onset of symptoms, inside which THROMBOLYSIS treatment is provided.
There is now recent concept of TISSUE WINDOW rather than TIME WINDOW (following the time clock),in which by certain sequences of MRI helps in giving THROMBOLYSIS treatment beyond this defined period of 4 hours 30 minutes.
Here is one example:
This 50 year old gentleman presented to emergency department at 5:45PM with symptoms of sudden onset loss of speech, right upper and lower limb weakness with gaze preference to left side since 12:45PM, comfortably outside the window period for thrombolysis.
NIHSS score was 17( which is stroke severity scale;more the score,more severe the stroke is)
He was living around 40 kilometers from here and his relatives immediately took him to nearby hospital, Unfortunately due to certain factors he was reffered here lately.
Anyway, knowing this fact we went ahead with MRI BRAIN of this patient which was showing medium sized infarcts in his left side of brain at multiple territories with FLAIR negativity (so called DIFFUSION-FLAIR MISMATCH) which is an advanced imaging marker indicating viable, salvagable brain tissue.
Despite the delayed presentation,decision to proceed with thrombolysis was made, guided by imaging rather than just the clock.
Thrombolysis was done at 6:15PM that is after 5 hours 30 minutes of onset of symptoms AND 30 minutes of reaching here (Door to needle time).
Outcome of patient was fascinating , His NIHSS score improved from 17 to 5 in next 16 hours.
