Thrombolysis in Very Minor Ischemic Stroke (NIHSS=0 or 1)

Thrombolysis in Very Minor Ischemic Stroke (NIHSS=0 or 1)

Background: Introduction: Intravenous thrombolysis (IVT) in minor ischemic stroke is controversial and often a minimum score of National Institute of Health Stroke Scale (NIHSS) is recommended for thrombolysis. Clinical characteristics, safety and outcome of very minor ischemic stroke (VMIS) treated by IVT were assessed.

Methods: Data of all patients treated with IVT during the last 5 years were extracted from a prospectively collected database. VMIS was defined as NIHSS=0 or 1 on admission. Baseline demographic data, symptoms, clinical and imaging findings, and outcome of VMIS patients were analysed.

Results: From 2010 to 2014, in total 477 patients were treated with IVT which included 12 VMIS (2.5%) patients. No complication or intracerebral haemorrhage occurred in the VMIS group. Median Rankin scale among VIMS patients improved from 4 at admission to 0 at discharge. Main symptoms of verified VMIS patients comprised mild aphasia/dysarthria (n=3) and gait ataxia (n=7), the latter not being registered by NIHSS.

Conclusions: This data add evidence that IVT may be safely performed in VMIS. VMIS incorporates often gait ataxia resulting from brainstem stroke which is not tested using the NIHSS. Thrombolysis decision should also be based on functional disability.


Thorleif Etgen

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