Recurrent ischemic stroke post-thrombolysis in an older Ghanaian woman

Acute ischemic stroke management has evolved through several paradigms. Currently, thrombolysis is recommended for patients who present within 4.5 hours of acute ischemic stroke. Early neurological deterioration post-thrombolysis, however, may occur through several mechanisms. We report a case of a 66-year-old Ghanaian woman with multiple co-morbidities who presented with sudden onset right-sided weakness and aphasia of 2 hours duration. A diagnosis of acute ischemic stroke was made based on clinical examination and a computerised tomography scan of the brain. She underwent successful thrombolysis with recovery of full neurological function. She, however, developed a second ischemic stroke within 72 hours, with the likely aetiology being large vessel occlusion. This was subsequently managed conservatively. Extensive evaluation and control of specific stroke aetiologies is required for the prevention of stroke recurrence post thrombolysis. Also, the establishment of comprehensive stroke centres which provide neurovascular interventions in sub-Saharan Africa can help reduce stroke mortality and morbidity in eligible patients.