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I have a question regarding tPA administration in a patient admitted with recurrent TIA's.
Hypothetical scenario:
65 year old man, previously healthy, presents with acute left sided weakness 3 hours prior to presentation that fully resolves upon initial evaluation. Thirty minutes later, he experiences right sided weakness, which again fully resolves within the span of a few minutes. He does not receive tPA. CT and MRI are then obtained and negative for acute stroke, CTA head / neck is unremarkable, and immediate cardiac studies are negative. If the patient again experiences symptoms concerning for stroke within a few hours, he would remain a candidate for tPA on the basis of the no prior history of stroke, correct? That is, the 3-4.5 hour window for tPA administration resets with each TIA if the symptoms fully resolve and / or the MRI is negative?
Also, is there any evidence of increased bleeding risk w/ tPA administration in this scenario?
Hypothetical scenario:
65 year old man, previously healthy, presents with acute left sided weakness 3 hours prior to presentation that fully resolves upon initial evaluation. Thirty minutes later, he experiences right sided weakness, which again fully resolves within the span of a few minutes. He does not receive tPA. CT and MRI are then obtained and negative for acute stroke, CTA head / neck is unremarkable, and immediate cardiac studies are negative. If the patient again experiences symptoms concerning for stroke within a few hours, he would remain a candidate for tPA on the basis of the no prior history of stroke, correct? That is, the 3-4.5 hour window for tPA administration resets with each TIA if the symptoms fully resolve and / or the MRI is negative?
Also, is there any evidence of increased bleeding risk w/ tPA administration in this scenario?
