Hemiplegia in acute ischemic stroke: A comprehensive review of case studies and the role of intravenous thrombolysis and mechanical thrombectomy

Abstract

Acute ischemic stroke is a significant health concern worldwide, often leading to long-term disability and decreased quality of life. Rapid and appropriate treatment is crucial for achieving optimal outcomes in these patients. Intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are two commonly used interventions for acute ischemic stroke, but their effectiveness in improving neurological symptoms and functional outcomes in patients with hemiplegia remains uncertain. The aim of this work was to evaluate the impact of IVT and MT within a 4.5-h time frame on patients with acute ischemic stroke and hemiplegia. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies that assessed the impact of IVT and MT within 4.5-h on hemiplegia in patients with an acute ischemic stroke were included. Data were extracted and analyzed to determine the overall effects of these interventions. Most included case reports indicate positive outcomes in terms of neurological symptom improvement and functional recovery in patients with hemiplegia after receiving IVT and MT within the specified time frame. However, the heterogeneity among the patients and the limited use of IVT due to contraindications posed challenges in determining the most effective treatment option. The findings from the included studies demonstrate that both interventions led to a decrease in National Institutes of Health Stroke Scale scores, indicating an improvement in neurological symptoms. The results highlight the beneficial effects of early thrombolytic interventions and MT on the neurological status and functional outcomes of patients with an acute ischemic stroke.

Keywords: brain; hemiplegia; ischemic stroke; thrombectomy; thrombolytic therapy.

Figure 1

A flowchart diagram, adhering to the PRISMA guidelines, illustrates the number of studies that underwent filtering, starting from the identification stage and culminating in their final inclusion in the analysis.

Figure 2

Comparison of National Institutes of Health Stroke Scale (NIHSS) scores before and after treatment in included studies. The bars in the figure represent the mean NIHSS scores before and after treatment for each study. The length of the bars reflects the magnitude of the scores. A decrease in the NIHSS score after treatment indicates an improvement in stroke severity. [Correction added on 2 March 2024, after first online publication: The figure 2 has been revised in this version.]