TS is an autosomal dominant disease known for over a century and recognized by characteristic hamartomata’s lesions involving any organ. In this report, we are presenting a patient with TS who presented with acute embolic stroke who received tPA and had a mechanical thrombectomy (MT). She had a dramatic response and without any hemorrhagic complications.

Case report : 

68-year-old Caucasian female with the past medical history of TS since childhood presented to the hospital with symptoms of left MCA syndrome (right-sided weakness, sensory loss, right facial droop, aphasia, hemianopia and dysarthria). NIHSS score was 19. CT head was negative for any acute abnormality except cortical tubers, sub-ependymal ventricular calcification. CT angiography of head and neck showed proximal occlusion of the left internal carotid artery. After ruling out all exclusion criteria, The patient received tPA and had a mechanical thrombectomy with complete reperfusion(TICI 3). Brain MRI showed acute stroke in the multivessel territories (bilateral parietal cortices, the left lentiform nucleus, medial left temporal lobe, left thalamus and right occipital lobe) suggestive of an embolic phenomenon and did not show any hemorrhagic complication. 

Discussion :

TS patients are at increased risk of intracerebral hemorrhage either in the setting of vascular malformation or due to hemorrhage into the subependymal giant cell astrocytoma. The best explanation for the latter could be secondary to elevated venous pressure from increased intracranial pressure.

Fortunately, our TS patient who presented with acute ischemic stroke was within the window and received tPA and mechanical thrombectomy. Patient not only did not have any hemorrhagic side effect afterwards but also had a significant improvement in her neurologic symptoms.

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