Intravenous Thrombolysis for Acute Ischemic Stroke Following Cervical Epidural Injection: A Case Report

TL;DR

A patient safely received stroke treatment after a recent spinal injection, showing it can be done without complications.

Contribution

This case report demonstrates the safe use of IVT for stroke following a cervical epidural injection.

Findings

An 83-year-old man received IVT after a cervical epidural injection without complications.

The patient showed symptom improvement following treatment.

Brain imaging confirmed no hemorrhage and a large vessel occlusion before treatment.

Abstract

A recent lumbar puncture (LP) is a relative contraindication for intravenous thrombolysis (IVT) due to the potential for the development of spinal hematoma. While there have been case reports of IVT administered without complications following LP or epidural anesthesia, there is limited data overall regarding the safety of IVT for acute ischemic stroke (AIS) in patients who have undergone a neuraxial procedure. We present a case report of an 83-year-old man who presented with a sudden onset of symptoms consistent with left middle cerebral artery (MCA) stroke after receiving a cervical epidural injection (CEI) earlier that same day. The patient received IVT after a comprehensive examination, including brain imaging that showed no intracranial hemorrhage and confirmed a large vessel occlusion (LVO), and a thorough assessment of the risks and benefits. There were no reported complications post treatment, and the patient showed improvement in symptoms on follow-up visits. This case report highlights the safe and successful administration of IVT for AIS following a recent CEI.

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