So, as you may have gathered from previous posts, I am not a huge fan of TPA in many cases of acute stroke for a whole variety of reasons – however, one of the biggest ones is that so many people that have acute strokes are ancient. Anyone I see with a stroke under age 80 is effectively an infant (and much more deserving of TPA in my opinion owing to lower incidence of side effects, etc) in my ER. Generally in those super old people with stokes there is underlying dementia and serious difficulty in ascertaining the onset of symptoms. However, once and a while you have a fairly straightforward story and exam and solid evidence of time of onset. However, even in those cases, when you are over 90, there is a real chance of bad outcome (bleeding, etc) so I always grit my teeth when we push the clot-busting juice. Even if these folks don’t bleed, it’s pretty uncommon for me to hear about, let alone see significant improvement of symptoms.
The other day was different however. We pushed TPA on a 92 year old fully functional guy within 2 hours of onset of symptoms and BAM !, he started improving during the 2 hours he waited for an ICU bed. His aphasia improved and he lost his facial droop. For once I felt good about the decision to give it in people born before WWI. Time will tell how he does over the next few days to weeks though.
What about born before the Spanish-American War?
WWI ended 1918. A 92 year old would have been born in 1919 or 1920.
You’re right. Born during the flu pandemic.
My dad had a stroke last Friday. Symptoms came on slow and were poorly recognized by my mother, so the doctors ruled out using TPA.
After a CT scan and an MRI, they determined that it was caused by a bleed. Very glad my Mom didn’t take him in right away when I heard that.