Acute Stroke With Hyperdense Middle Cerebral Artery (MCA) Sign in an Adolescent Female With Tyrosine Kinase Inhibitor Treatment—What You Need to Know

Background

Acute stroke in an adolescent patient is a rare phenomenon. Tyrosine kinase inhibitors (TKIs) are newer targeted anticancer medications without widespread side effects typically associated with traditional chemotherapy. However, recent literature reveals several potential life-threatening side effects.

Case Report

We present an unusual case of acute stroke with hyperdense middle cerebral artery (MCA) sign, in a 16-year-old female with a history of rhabdomyosarcoma and recent treatment with pazopanib, a tyrosine kinase inhibitor (TKI). The patient developed sudden right-sided weakness at school. She was brought to the emergency department (ED) by her parents. Prompt diagnosis with noncontrast computed tomography (CT)-brain and CT angiogram of head and neck followed by immediate administration of thrombolytic treatment with alteplase and referral for mechanical thrombectomy resulted in a successful restoration of blood flow and a favorable clinical outcome. This paper highlights the importance of recognizing stroke symptoms in young patients with a history of malignancy, discusses the risks associated with TKI treatment, and the efficacy of the treatment modalities employed.

Why Should an Emergency Physician Be Aware of This?

Emergency physicians should be mindful of the many new targeted anticancer therapies and their potential deleterious side effects. Due to the lack of pediatric stroke guidelines, adult stroke guidelines may be applied in the management of adolescent patients with acute stroke. Emergency physicians should also be able to recognize a hyperdense MCA sign on a noncontrast CT scan of the brain in a patient presenting with anterior circulation stroke symptoms.