Intravenous Thrombolysis in Ischemic Stroke Patients With Isolated Homonymous Hemianopia

Abstract

on behalf of SITS InvestigatorsBackground and Purpose-Hemianopia can cause considerable disability. Only scarce data are available for ischemic stroke patients presenting with isolated homonymous hemianopia and being treated with intravenous thrombolysis. We analyzed outcome of such patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register (SITS-ISTR). Methods-The SITS-ISTR (nϭ45 079) was searched for patients who presented with isolated homonymous hemianopia.We identified 72 such patients. We report their baseline and demographic characteristics, radiological data, change in their National Institutes of Health Stroke Scale score within 7 days after thrombolysis, and their 3-month modified Rankin Scale (mRS) score. Univariate analysis of parameters associated with any improvement was performed. Hemianopia was assessed with perimetric examination. Results-Of 72 patients, 40 (56%) improved within 7 days after thrombolysis; 19 (26%) had full recovery. Those who improved had significantly lower systolic blood pressure before thrombolysis and were less often administered antiplatelet agents before index stroke. Infarction was visible on 24-hour computed tomography scan in 65% of patients who improved compared with 81.2% of those without improvement (Pϭ0.32). No symptomatic intracranial hemorrhage occurred in patients who improved compared with 1 (3.1%) patient in the nonimproved group (Pϭ0.08). Seventy-one percent of all patients had 3-month mRS score 0 to 2, and 51% had mRS score 0 to 1. Those who improved within 7 days had a significantly better 3-month outcome (median mRS [interquartile range], 0 [0 -1] vs 2 [1-2]). Conclusions-Relatively few ischemic stroke patients received thrombolysis because of isolated homonymous hemianopia. Thrombolysis seems to be safe in these patients. Of those treated, more than half improved and more than two-thirds had good outcome. (Stroke. 2012;43:2695-2698.)

Intravenous thrombolysis in ischemic stroke with unknown onset using CT perfusion

“…In our series, 22% of the patients with unknown onset had to be excluded from thrombolysis due to too large infarct cores detected by CTP that had been missed by initial NCCT. Thus, our results support the need to perform advanced neuroimaging techniques, including CTP, in this particular subgroup of patients to select the best candidates for reperfusion therapies (19,20).…”

“…Early reperfusion may have no therapeutic effect in delayed patients with a no-mismatch profile, or can even be harmful and associated with fatal intracranial hemorrhage in patients with a malignant profile, who are characterized by large infarct cores. Thus, our results support the need to perform advanced neuroimaging techniques, including CTP, in this particular subgroup of patients to select the best candidates for reperfusion therapies (19,20). In our series, 22% of the patients with unknown onset had to be excluded from thrombolysis due to too large infarct cores detected by CTP that had been missed by initial NCCT.…”

Pomona Large Vessel Occlusion Screening Tool for Prehospital and Emergency Room Settings

“…Neglect or extinction indicates the involvement of the right temporal lobe, insular lobe, putamen, and caudate nucleus of the nondominant hemisphere [21]. Isolated visual field defects from acute ischemic strokes are very rare (approximately 0.16%) [22]. The majority of homonymous visual field defects are caused by occipital lobe involvement (40%), which is supplied by the posterior cerebral artery [22].…”

“…Isolated visual field defects from acute ischemic strokes are very rare (approximately 0.16%) [22]. The majority of homonymous visual field defects are caused by occipital lobe involvement (40%), which is supplied by the posterior cerebral artery [22]. …”

Treatment of acute stroke: an update

“…A treatment decision in these cases should be based on the clinical importance of the symptoms and information from neuroimaging [71]. For example, isolated dysphasia, contributing only one or two points on the NIHSS, may be a clinically significant deficit prompting treatment; another example is isolated haemianopia (frequently due to posterior cerebral artery occlusion) [72].…”