Background: Managing acute ischemic stroke in patients with significant comorbidities, such as hypertension, heart failure, and substance abuse, presents unique challenges. Timely intervention is critical, but the risk of complications and poor prognosis is high.
Case Presentation: A 46-year-old male with a history of smoking, drug abuse, poorly controlled hypertension, and dilated cardiomyopathy (DCM) with an ejection fraction of 25-30% presented with sudden left-sided weakness, facial droop, and dysarthria. Initial NIHSS score was 6. CT brain showed no acute infarctions but revealed chronic lacunar infarctions and atrophy. CT angiography identified significant vascular abnormalities, including right internal carotid artery attenuation and non-visualization of both intracranial vertebral and basilar arteries. Intravenous thrombolysis (tPA) led to initial improvement, but recurrent strokes or TIAs followed, leading to intubation and mechanical ventilation. MRI revealed evolving infarctions in the pons and cerebellum. A basilar artery thrombectomy was successfully performed, but postoperative complications included spontaneous pneumothorax and femoral artery pseudoaneurysm, requiring further interventions. Due to extensive posterior circulation infarction, the patient had a poor neurological prognosis and was placed on Do Not Resuscitate (DNR) status.
Conclusion: This case highlights the complexities of treating acute ischemic stroke in patients with substantial comorbidities. While interventions such as thrombolysis and thrombectomy are critical, they carry risks. A multidisciplinary approach is necessary to balance immediate treatment with considerations of long-term prognosis and quality of life.
Keywords: Acute ischemic stroke, dilated cardiomyopathy, thrombolysis, basilar artery thrombectomy, transient ischemic attacks, posterior circulation infarction, comorbidities.cerebrovascular disease, posterior circulation infarction, neurological complications, hypertension, drug abuse.
Key words: Brainstem stroke, TIAs, Basilar occlusion.
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