Abstract
Objective: N/A
Background: The FDA has approved implanted neuro-stimulation devices, including Deep Brain Stimulation (DBS) for Parkinson’s Disease (PD) and Essential Tremor (ET) and responsive neuro-stimulation (NeuroPace RNS) for patients with refractory focal seizures. These implanted brain stimulators will become more common in clinical practice over the coming years. There is a paucity of literature establishing the safety of intravenous tPA administration in these patients presenting with symptoms of acute ischemic stroke. The authors present the first published case of i.v. tPA given to a 40 year old woman with the NeuroPace RNS device for refractory focal epilepsy resulting in complete resolution of neurologic symptoms.
Design/Methods: The patient’s NeuroPace device was implanted 2.25 years prior to presenting to a community hospital with acute onset of aphasia and dense right hemiparesis and an initial NIH stroke scale of 16. She was assessed by telestroke 65 minutes after onset of symptoms and received intravenous tPA bolus at 98 minutes following symptom onset. She was then transported to our facility for consideration of intra-arterial therapies. On arrival to our ED, however, her NIH stroke scale had improved to 0. CT angiography elucidated the cause of the stroke to be a carotid artery dissection.
Results: Thrombolysis was successful in the setting of an implantable neurological device without any complications.
Conclusions: This report describes the first known administration of i.v. tPA to a patient with refractory focal epilepsy and an implanted neurostimulator device. The presence of these devices should not be considered a contra-indication to the administration of thrombolysis as long as the implantation occurred over 3 months prior.
Disclosure: Dr. Henninger has nothing to disclose. Dr. Morris has nothing to disclose. Dr. Goodman has nothing to disclose. Dr Jobst has nothing to disclose.
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