BACKGROUND Intravenous thrombolysis is a well-established treatment of ischemic stroke within 4.5 h. However, its effectiveness in acute ischemic myelopathy is unknown. PURPOSE We describe a series of four acute ischemic myelopathy patients treated with intravenous thrombolysis within 4.5 h and review the current literature to explore this treatment feasibility, potential safety, and efficacy. METHODS We reviewed all routinely collected clinical, radiological, and follow-up data of patients with a final acute ischemic myelopathy diagnosis who received acute intravenous thrombolysis in our stroke network. We also reviewed thrombolyzed acute ischemic myelopathy patients in the literature. RESULTS Four patients (three women) aged 57 to 83 years presented with acute uni- or bilateral extremity paresis, considered initially as cerebral strokes in two of them. After excluding contraindications by brain imaging in three, spinal computed tomography in one and confirmation of acute ischemic myelopathy on spinal magnetic resonance imaging in one patient, intravenous thrombolysis was administered at 135, 190, 240, and 245 min accordingly. Subacute diffusion-weighted imaging-magnetic resonance imaging confirmed acute ischemic myelopathy in all but one patient. Favorable outcome was achieved in two patients rapidly and in three patients at three-month follow-up. We identified seven other thrombolyzed acute ischemic myelopathy patients in the literature, who showed variable recovery and no hemorrhagic complications. CONCLUSIONS With appropriate acute imaging, intravenous thrombolysis after acute ischemic myelopathy is feasible and potentially safe within 4.5 h. Given the potential of benefit of thrombolysis in acute ischemic myelopathy, this treatment warrants further efficacy and safety studies.

中文翻译：

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静脉溶栓治疗急性缺血性脊髓病：四例新病例并文献复习。

背景技术静脉溶栓是一种公认​​的治疗缺血性中风的方法，治疗时间为4.5小时。然而，其在急性缺血性脊髓病中的有效性尚不清楚。目的我们描述了一系列4名在4.5小时内接受静脉溶栓治疗的急性缺血性脊髓病患者，并回顾了当前文献以探讨该治疗的可行性，潜在的安全性和有效性。方法我们回顾了所有常规收集的临床，放射学和随访数据，这些患者均在我们的卒中网络中接受了急性静脉溶栓治疗，最终诊断为急性缺血性脊髓病。我们还回顾了文献中溶栓的急性缺血性脊髓病患者。结果4例年龄在57至83岁之间的患者（3名女性）出现了急性单侧或双侧肢体轻瘫，最初被认为是其中两个的脑中风。在排除了三项中通过脑部成像禁忌症，一项中排除了脊髓计算机断层扫描并在一名患者的脊髓磁共振成像中确认了急性缺血性脊髓病之后，分别在135、190、240和245分钟进行了静脉溶栓治疗。亚急性弥散加权成像-磁共振成像证实除一名患者外所有患者均患有急性缺血性脊髓病。在三个月的随访中，有2例患者迅速获得了良好的结果，而3例患者中获得了3例患者的良好结果。我们在文献中确定了其他七名溶栓的急性缺血性脊髓病患者，他们表现出可变的恢复并且没有出血并发症。结论通过适当的急性影像学检查，急性缺血性脊髓病后静脉溶栓治疗是可行的，并且可能在4.5小时内安全。鉴于溶栓治疗在急性缺血性脊髓病中具有潜在的益处，这种治疗值得进一步的疗效和安全性研究。