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Use of Intravenous Tissue Plasminogen Activator in a 16-Year-Old Patient with Basilar Occlusion

University of Cincinnati Department of Neurology, Cincinnati, Ohio, heiljw{at}email.uc.edu

Laurel Malinowski, MD

University of Cincinnati Department of Neurology, Cincinnati, Ohio

Andrea Rinderknecht, MD

University of Cincinnati Department of Neurology, Cincinnati, Ohio

Joseph P. Broderick, MD

University of Cincinnati Department of Neurology, Cincinnati, Ohio

David Franz, MD

University of Cincinnati Department of Neurology, Cincinnati, Ohio

Intravenous tissue plasminogen activator (t-PA) is currently approved by the US Food and Drug Administration (FDA) for the treatment of ischemic stroke in patients > 18 years of age who present within 3 hours of stroke onset and meet certain criteria. We report a case of a 16-year-old, previously healthy female who presented with a basilar artery occlusion and pontine ischemic stroke. She was treated with intravenous t-PA approximately 4 hours after the onset of symptoms. The patient demonstrated a remarkable recovery 6 hours after onset of her symptoms and had minimal deficits on discharge from the hospital 1 week later. She was found to have a lupus anticoagulant and was heterozygous for the prothrombin gene G2010A mutation. These were likely contributing causes for her stroke. She was also homozygous for plasminogen activator inhibitor 1 (PAI-1) 4G/4G, which at present is a controversial stroke risk factor.

Key Words: arterial ischemic stroke • tissue plasminogen activator • lupus anticoagulant

Journal of Child Neurology, Vol. 23, No. 9, 1049-1053 (2008)
DOI: 10.1177/0883073808319076


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