Real-time monitoring of blood flow changes during intravenous thrombolysis for acute middle cerebral artery occlusion.

Dear Editor, We report a 62-year-old Chinese man who presented 90 minutes after right-sided weakness and inability to speak of sudden onset. He had been taking medications for hypertension and hypercholesterolaemia for 5 years. On examination, he was conscious with an irregularly irregular pulse and blood pressure of 168/95 mmHg. Neurological examination was remarkable for a forced left gaze, global aphasia and profound right hemiplegia (Power, Medical Research Council – MRC grade 0) with the National Institute of Health Stroke Scale (NIHSS) score of 23 points. While no early ischaemic changes were noted in the non-contrast-enhanced brain computed tomography (CT), CT angiography (Fig. 1A) revealed an occlusion of left proximal middle cerebral artery (MCA). Intravenous tissue plasminogen activator (IV-TPA) was initiated at 135 minutes after the symptom-onset (0.9 mg/kg body weight with 10% given as IV bolus and the rest infused over 60 minutes). We performed continuous monitoring of the left MCA fl ow with 2-MHz Transcranial Doppler (TCD) and the spectral fl ow signals were graded according to the Thrombolysis In Brain Ischaemia (TIBI) Real-time Monitoring of Blood Flow Changes during Intravenous Thrombolysis for Acute Middle Cerebral Artery Occlusion