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One therapeutic challenge - acute stroke by occlusion on M1 portion of the MCA - case report

Silva Andonova, Zvetomila Dimitrova, Evgenia Kalevska, Ðœarina Petkova, Vania Argirova, Penka Kirilova, Zvetan Zvetkov, Ðœarianna Novakova, Radoslav Georgiev

Abstract

PURPOSE: To discuss the therapeutic possibilities for treatment of malignant infarction by occlusion on M1 portion of the MCA.

MATERIAl AND METHODS: The study was performed in a 35-year-old patient with acute ischemic stroke and left sided hemiparesis one hour before hospitalization. Intravenous t-PA was performed regarding the inclusion/exclusion criteria by protocol.

RESUlTS: By reason of progression of neurological deficit and loss of consciousness MRI was performed in the next 24 hours. On MRI and MRI angiography ischemic stroke with haemorrhagic transformation in the right MCA and dislocation on the left were seen. The patient was treated by decompressive craniectomy. A converse development of focal neurological symptoms to mild central left-sided hemiparesis was reported with present good results.

DISCUSSION: The presentation of this clinical case shows that some of the patients with acute ischemic stroke may benefit from a decompressive craniectomy. The timing and indications for this potential lifesaving procedure are still debated, there are no well-defined selection criteria for performing the surgery in case of supratentorial infarctions.


Keywords

stroke; decompressive craniectomy

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DOI: http://dx.doi.org/10.14748/ssm.v46i2.685

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About The Authors

Silva Andonova
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Zvetomila Dimitrova
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Evgenia Kalevska
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Ðœarina Petkova
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Vania Argirova
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Penka Kirilova
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Zvetan Zvetkov
St. Marina University Hospital of Varna
Bulgaria

Second Clinic of Neurology

Ðœarianna Novakova
St. Marina University Hospital of Varna
Bulgaria

Centre of Radiology

Radoslav Georgiev
St. Marina University Hospital of Varna
Bulgaria

Centre of Radiology

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