Abstract
A delay in recognising acute posterior circulation infarct (POCI) can cause a delay in treatment and high mortality rate. There has been an increasing trend in incidence of stroke among the elderly. Treating acute stroke in elderly has been challenging due to the lack of data on the functional outcome and mortality risk. A 97-year-old woman had left sided weakness upon waking up from sleep and dizziness two days prior. Upon arrival, her Glasgow Coma Scale (GCS) was E3V4M6, BP 162/112 mmHg, NIHSS score 10, left sided power 3/5 and right sided power 4/5. Her computed tomography (CT) angiography brain showed P2 segment of right posterior cerebral artery and distal basilar artery thrombosis, with a posterior circulation territory mismatch. Thrombolysis was given immediately. She was discharged with NIHSS 5, GCS E4V5M6 and power bilateral limbs 4/5. She was put on lifelong Apixaban for stroke prevention and underwent post-stroke rehabilitation. The time of occlusion was decided based on the time a patient was last seen well. Studies have shown that patients aged 80 years and above presenting within 3-4.5 hours from symptoms, perform well with both intravenous thrombolysis and thrombectomy, with no increased risk for intracranial hemorrhage and death.
Keywords :
Dizziness; elderly; NIHSS; posterior circulation infarct; thrombolysis,
Abstrak
Kelewatan dalam mengenal pasti 'posterior circulation infarct' akut boleh menyebabkan kelewatan dalam rawatan dan kadar kematian yang tinggi. Terdapat peningkatan dalam kejadian strok di kalangan orang tua. Rawatan strok akut untuk orang tua sangat mencabar disebabkan oleh kekurangan data mengenai komplikasi dan hasil fungsi mereka. Seorang wanita berusia 97 tahun mengalami kelemahan di bahagian kiri badannya ketika bangun dari tidur dan pening dua hari sebelumnya. Apabila tiba di hospital, skala 'Glasgow Coma' (GCS) beliau adalah E3V4M6, tekanan darah 162/112 mmHg, skor NIHSS 10, kekuatan di bahagian kiri badan 3/5 dan di bahagian kanan badan 4/5. Pemeriksaan tomografi komputer (CT) otak menunjukkan trombosis pada segmen P2 arteri serebrum posterior sebelah kanan dan arteri basilar distal, dengan 'posterior circulation mismatch'. Trombolisis diberikan segera. Beliau dibenarkan discaj dengan NIHSS 5, GCS E4V5M6 dan kekuatan pada kedua-dua anggota badan 4/5. Beliau diberi Apixaban seumur hidup untuk pencegahan strok dan menjalani rehabilitasi pasa-strok. Masa thrombosis dianggarkan berdasarkan masa terakhir pesakit kelihatan sihat. Kajian telah menunjukkan bahawa pesakit yang berusia 80 tahun ke atas yang hadir ke hospital dalam masa 3-4.5 jam selepas gejala, menunjukkan pemulihan yang baik dalam aspek fungsi anggota badan jika dirawat dengan trombolisis intravena atau trombektomi, tanpa peningkatan risiko pendarahan otak dan kematian.
Kata Kunci :
Infark cirkulasi posterior; NIHSS; orang tua; pening; trombolisis,
Correspondance Address
Dr Wan Asyraf Wan Zaidi. Neurology Unit, Department of Medicine, Level 8, Clinical Block, Hospital Canselor Tuanku Muhriz, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras Kuala Lumpur, Malaysia. Tel: +6013-3884836 Email: drwawz87@gmail.com
