J Korean Neurosurg Soc.  2006 Apr;39(4):300-302.

"Brain Stunning" Atypical Feature of tPA Thrombolysis Following Aneurysm Embolization

• Park MW
• Yi HJ
• Gupta R
• Horowitz M

Abstract

"Stunning" represents prolonged contractile depression of any muscular component after alleviation of severe ischemia, as shown in reperfusion following acute myocardial ischemia or ischemic stroke. Clinically, it presents with no or delayed recovery past to thrombolytic therapy but its pathogenic mechanism is not fully uncovered yet. We describe a unique case of a 63-year-old woman, who was undertaken endovascular coiling for the aneurysms, deteriorated several hours later without known cause, and showed delayed clinical improvement over the next 3 days following thrombolysis. Immediate post-thrombolysis magnetic resonance imaging scan showed no apparent abnormality except for high signal intensity within the corresponding hemisphere. Reversible, but delayed nature of "brain stunning" can be explained by these images and it seems to be caused by a certain type of reperfusion injury.

Keyword

Acute ischemic stroke; Endovascular coiling; Magnetic resonance imaging; (Brain) Stunning; Thrombolytic therapy

MeSH Terms

Aneurysm*
Depression
Female
Humans
Ischemia
Magnetic Resonance Imaging
Middle Aged
Myocardial Ischemia
Reperfusion
Reperfusion Injury
Stroke
Thrombolytic Therapy