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Volume 350:2213-2214 May 20, 2004 Number 21
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Case 5-2004: A Man with Slurred Speech and Left Hemiparesis

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by Carter, B. S.
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To the Editor: Case 5-2004 (Feb. 12 issue)1 demonstrates the substantial progress that has been made in the treatment of cerebrovascular diseases. However, we have reservations regarding the management of this case. Early ischemic changes on computed tomography (CT) and a high score on the National Institutes of Health Stroke Scale (NIHSS) at presentation indicate a high risk of symptomatic hemorrhagic transformation and of a poor outcome after thrombolysis.2,3 Considering its high risk–benefit ratio and the marginal overall benefit it confers, the use of intravenous tissue plasminogen activator (t-PA) in this case was controversial; moreover, the use of intraarterial t-PA . . . [Full Text of this Article]



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