Case Report/Case SeriesSuccessful Systemic Thrombolysis in an Adolescent With Acute Ischemic StrokeViaro, Federica MD*; Manara, Renzo MD†; Farina, Filippo MD*; Palmieri, Anna MD*; Rocca, Foscarina D. MD‡; Ballotta, Enzo MD§; Baracchini, Claudio MD* Author Information Departments of *Neurological Sciences †Neuroradiology ‡Emergency Medicine §Vascular Surgery Group, 2nd Surgical Clinic, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua School of Medicine, Padua, Italy F.V. and R.M. should be considered as “first co-authors.” Informed consent was obtained from the patient and his parents for the publication of this paper. The authors declare no conflict of interest. Reprints: Federica Viaro, MD, Department of Neurological Sciences, University of Padua School of Medicine, Via Giustiniani 5, Padua 35128, Italy. E-mail: [email protected]. The Neurologist: September 2015 - Volume 20 - Issue 3 - p 48-50 doi: 10.1097/NRL.0000000000000050 Buy Metrics Abstract Introduction Current treatment guidelines for acute ischemic stroke do not recommend thrombolytic therapy in children and adolescents as data are still very scarce. Case Report: We report the case of a 15-year-old boy who suddenly developed severe left-sided weakness and speech difficulty while stooling. Upon arrival at our Emergency Department, the National Institute of Health Stroke Scale (NIHSS) score was 18. Urgent neurovascular ultrasound showed a distal occlusion of the right internal carotid artery and occlusion at the origin of the middle cerebral artery (MCA) and the anterior cerebral artery. He was treated 2 hours after symptom onset with intravenous recombinant tissue plasminogen activator without any complication. At the end of thrombolysis, a complete recanalization was shown by transcranial Doppler sonography, although a brain magnetic resonance imaging disclosed an acute right middle cerebral artery stroke. At discharge, the boy had mild weakness on his left leg and slight left facial palsy: the NIHSS score was 2. To our knowledge, this is the first intravenous thrombolytic treatment ever reported in an adolescent in Italy. Conclusions: Despite the lack of evidence regarding the safety and the efficacy of recombinant tissue plasminogen activator in pediatric stroke, this treatment option should be considered, especially in adolescents presenting within 3 hours from symptom onset in centers with consolidated experience in adult thrombolysis. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.