INTRAVENOUS THROMBOLYSIS WITH TENECTEPLASE FOR ACUTE ISCHEMIC STROKE AT 10 WEEKS OF PREGNANCY: A CASE REPORT

Abstract

Acute ischemic stroke during pregnancy is rare, but any delay in treatment can expose both the mother and the fetus to preventable risks. The evidence supporting the use of intravenous thrombolysis during pregnancy comes largely from observational studies and case reports, and experience with tenecteplase remains particularly limited. We report the case of a 34-year-old woman (G3P1), 10 weeks into her pregnancy, who presented two hours after the sudden onset of left-sided hemiplegia, facial weakness, hemisensory loss, dysarthria, and partial homonymous hemianopia. Her NIHSS (National Institutes of Health Stroke Scale) score was 13, and her blood pressure was 210/100 mmHg. The brain MRI noted restricted diffusion in the right posterior limb of the internal capsule, with no corresponding FLAIR abnormality. After reducing the blood pressure to 180/100 mmHg and confirming an ongoing intrauterine pregnancy, tenecteplase was administered intravenously at a dose of 0.25 mg/kg, 3 hours and 35 minutes after the onset of symptoms. The NIHSS score improved to 9 after 30 minutes, then to 4 after eight hours. A follow-up Brain MRI performed 24 hours later revealed no intracranial hemorrhage. No immediate obstetric bleeding was observed, and fetal heart activity was still present. This case demonstrates that pregnancy alone should not automatically preclude reperfusion therapy in the event of a disabling ischemic stroke. It also highlights the need for rapid multidisciplinary decision-making, meticulous blood pressure control, and structured maternal and obstetric monitoring when tenecteplase is used in early pregnancy.