Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neuropsychiatry

Background : Recombinant tissue-type plasminogen activator (alteplase) was first approved by the FDA in the United States in 1996 and remains the only medication proven to affect outcome when given in the hyperacute time frame (up to 4.5 hours from onset) after ischemic stroke.Aim of work: To evaluate the impact of thrombolytic therapy on early outcome in acute ischemic stroke patients compared by conventional management.Patients and Methods: A case control prospective study was conducted on 189 acute ischemic stroke patients who were divided into two groups: group I including 75 patients who received rtPA within time widow (up to 4.5 hour) and group II including 114 patients who presented beyond time window and did not receive rtPA. All participants underwent full neurological assessment; NIHSS on admission, follow up assessment was done by NIHSS at day 7 and mRS after 7 days and 90 days. Laboratory tests, CT brain imaging, MRI and other imaging modalities when available were done.Results: Advanced age correlate significantly with unfavorable outcome in patients who received thrombolytic therapy (rtPA). Patients with mild stroke and received rtPA showed a significant improvement compared with those who did not receive. In patients who received rtPA, assessment at time of admission by NIHSS correlate significantly with the scores of further evaluation with NIHSS at day 7 and mRs both at day 7 and 3 months. In patients who received rtPA, those with mild stroke severity had a significant the most favorable outcome, however those with moderate and severe stroke had significantly more unfavorable outcome than those with mild stroke severity. Patients with Total Anterior circulation syndrome had significant unfavorable outcome

Issued also as CD