The 70-year-old male patient, went to the emergency room complaining of rapid onset right-sided weakness, slurred speech, and trouble walking. His medical history included a history of hypertension, and he was a smoker. The patient's clinical examination revealed: pulse rate was 90 beats per minute, blood pressure was 170/90 mmHg, respiratory rate was 18 breaths per minute, oxygen saturation was 98% on room air and body temperature was normal. An evaluation of the patient's nervous system revealed the following: The National Institutes of Health Stroke Scale (NIHSS) score was 12; 2 points were assigned for dysarthria, 2 points were assigned for partial facial paralysis, and 8 points were assigned for right limb weakness, Muscle strength in right-sided upper and lower limbs: 0/5; left-sided upper and lower limbs: 5/5. The physical examination indicated clear awareness, dysarthria, a shallow right nasolabial groove, a left-angled mouth, grade 0 muscle strength in the right limb, low muscle tension, and a positive Babinski sign (+) on the right side.
In line with the stroke protocol, the patient was immediately sent for an Magnetic resonance imaging (MRI), which indicated an infarct in the location (Fig-1 A,B) of the middle cerebral artery (MCA). After the beginning of symptoms, the patient was an excellent candidate for thrombolysis with Alteplase since he was taken to the emergency center within one hour, a stroke protocol MRI was performed within twenty minutes, and the medicine Alteplase was administered within two hours. After satisfying the RT-PA indications, intravenous Alteplase treatment at the worldwide standard dosage of 0.9 mg/Kg is administered. 50 mg of intravenous alteplase was provided at a lower dosage of 0.9 mg/kg, with 10% (5 mg) given as a bolus over 1 minute and the remaining 90% (45 mg) mixed to 400 mL of 0.9% normal saline (N/S) to run over 1 hour. The interdisciplinary team lead by Consultant neurologists and Consultant radiologist made the choice to deliver Alteplase at such in a critical situation within the specified time frame.
During medication monitoring, the patient reported an improvement in dizziness symptoms, clearer speech, normal left limb function, and an NIHSS score of 2.
A close watch was kept on the patient in the event that Alteplase had adverse consequences, such as bleeding or allergic reactions. Twenty-four hours following alteplase administration, a repeat MRI of the brain revealed successful recanalization of the M1 section of the middle cerebral artery and healthy vascular collaterals (Fig. 1: C,D). In the first twenty-four hours following the injection of Alteplase, the patient's blood pressure was maintained below 180/90 mmHg and he did not require any anticoagulant medication. On the third day of admittance, he had made tremendous progress, with a power of 4/5 in his right upper and lower limbs and the ability to respond appropriately to inquiries with his voice. Reading, naming, and repeating were intact, and the individual was able to grasp directives. As his symptoms improved, he stepped down to cabin and afterwards discharged from the hospital on the fifth day on oral atorvastatin and low-dose aspirin and advised to continue outpatient physiotherapy and hospital follow-up at outpatient department (OPD).