Location
Philadelphia, PA
Start Date
3-5-2023 1:00 PM
End Date
3-5-2023 4:00 PM
Description
An 86-year-old African American female presented to a community hospital with intractable left shoulder pain and was admitted for the correction of electrolyte abnormalities. Three days into her hospital course, she developed altered mental status, dysarthria, and facial droop. A CT scan showed no evidence of acute intracranial hemorrhage. After neurologic evaluation and informed consent was given by the patient’s daughter, the decision was made to administer intravenous t-PA for the treatment of acute ischemic stroke. Two hours after tPA administration, a CT scan showed no evidence of hemorrhagic conversion. Four hours later, the patient began to complain of redness, irritation, and decreased visual acuity in the right eye. Over the course of the day, the patient’s visual acuity progressed to hand motion in the right A repeat CT scan was performed 16 hours after t-PA administration showed hemorrhage in the posterior aspect of the right globe. The patient was started on intraocular pressure lowering agents and transferred to a tertiary care facility for ophthalmologic evaluation.This case demonstrates the rare consequence of vision loss following tPA administration for acute ischemic stroke. Vision loss has rarely been reported in the literature due to t-PA usage. Two previous cases of vision loss were reported after t-PA usage for ischemic stroke, while there have been other reports after its usage for the treatment of myocardial infarction. In all previously reported cases, a history of ocular disease predisposing the patients to retinal neovascularization such as a central retinal vein occlusion or proliferative diabetic retinopathy was present. The authors believe this is the first reported case of intraocular hemorrhage as a consequence of t-PA usage where the patient did not have any previous diagnosed ocular disease. This underlines the importance that permanent vision loss should be discussed as a potential complication when obtaining informed consent for the use of intravenous t-PA for the treatment of acute ischemic stroke.
Embargo Period
6-28-2023
Included in
Vision loss: A rare complication of intravenous t-PA in the treatment of acute ischemic stroke
Philadelphia, PA
An 86-year-old African American female presented to a community hospital with intractable left shoulder pain and was admitted for the correction of electrolyte abnormalities. Three days into her hospital course, she developed altered mental status, dysarthria, and facial droop. A CT scan showed no evidence of acute intracranial hemorrhage. After neurologic evaluation and informed consent was given by the patient’s daughter, the decision was made to administer intravenous t-PA for the treatment of acute ischemic stroke. Two hours after tPA administration, a CT scan showed no evidence of hemorrhagic conversion. Four hours later, the patient began to complain of redness, irritation, and decreased visual acuity in the right eye. Over the course of the day, the patient’s visual acuity progressed to hand motion in the right A repeat CT scan was performed 16 hours after t-PA administration showed hemorrhage in the posterior aspect of the right globe. The patient was started on intraocular pressure lowering agents and transferred to a tertiary care facility for ophthalmologic evaluation.This case demonstrates the rare consequence of vision loss following tPA administration for acute ischemic stroke. Vision loss has rarely been reported in the literature due to t-PA usage. Two previous cases of vision loss were reported after t-PA usage for ischemic stroke, while there have been other reports after its usage for the treatment of myocardial infarction. In all previously reported cases, a history of ocular disease predisposing the patients to retinal neovascularization such as a central retinal vein occlusion or proliferative diabetic retinopathy was present. The authors believe this is the first reported case of intraocular hemorrhage as a consequence of t-PA usage where the patient did not have any previous diagnosed ocular disease. This underlines the importance that permanent vision loss should be discussed as a potential complication when obtaining informed consent for the use of intravenous t-PA for the treatment of acute ischemic stroke.