Obstructive sleep apnea exaggeration as predictor of poor outcome post thrombolytic stroke

Abstract

Obstructive sleep apnea (OSA) is a common sleep disordered breathing in stroke patients. This case report aimed to show the presence of OSA in stroke can contribute to the increasing chance of mortality and morbidity. We presented a case of first-time stroke in a 64-year-old female with a history of pre-stroke OSA. She underwent intravenous thrombolysis as main therapy within the time limit under 4.5 hours since the stroke onset. She had prolonged hospital stay due to complications from OSA, even though she only had a small ischemic core (9 mL) in follow-up radiological imaging and was discharged with a greater National Institutes of Health Stroke Scale (NIHSS) score than admission (5 to 10). OSA can be one of warning signs for poor prognosis in stroke patients. Understanding the presence of OSA not only can be beneficial toward choosing the next steps of therapy, but also important for the rehabilitation and recovery period of stroke patients.

Keywords: CT perfusion; Obstructive sleep apnea; Stroke; Thrombolysis; rtPA.

Fig. 1

Non contrast MRI in T2W (A) and T2-FLAIR (B) showed no sign of bleeding to exclude the thrombolysis contraindication.

Fig. 2

Automated brain computed tomography perfusion imaging, hypoperfusion area is seen in the infarcted region in the left frontoparietotemporal region (CBF<30% in corresponding to 9 mL ischemic core, and Tmax > 6s accounts for hypoperfusion area of 245 mL, with mismatch volume of 236 mL and ratio of 27.2).