Recanalization of middle cerebral artery and intracranial aneurysm in the same ischemic territory with intravenous administration of recombinant tissue plasminogen activator: case report

Abstract

We report a case of middle cerebral artery (MCA) embolism accompanied by unruptured intracranial aneurysm in the same ischemic MCA territory, successfully treated with intravenous administration of recombinant tissue plasminogen activator (rt-PA). A 66-year-old right-handed man presented with abruptly decreased consciousness and right motor paralysis. He had a National Institute of Health Stroke Scale (NIHSS) score of 26 points on admission. Computed tomography scan showed a hyperdense MCA sign on the left, and magnetic resonance angiography (MRA) demonstrated left MCA occlusion. Acute ischemic stroke was diagnosed, and rt-PA was administered intravenously. MRA at 2 weeks after onset demonstrated recanalization of the occluded left MCA and an aneurysm in the ischemic territory. The patient's NIHSS and modified Rankin Scale scores were each 1 at 3 months after onset. Recanalization of both the occluded MCA and the occluded intracranial aneurysm in the same ischemic territory was neuroradiologically confirmed. This case illustrates that the efficacy, safety, and risk of hemorrhage during intravenous thrombolysis for acute ischemic stroke patients with unruptured intracranial aneurysm merit further examination.