Background and Aims: guidelines indicate thrombolysis as one of the treatments for stroke during pregnancy. Actually, treatment is often delayed or not given, because of highlighted relative contraindications. The major risks are maternal hemorrhagic complications. Method: A 43-year-old woman, 30 weeks pregnant, presented within 120 minutes of abrupt onset of left-sided hemiparesis. Diffusion-weighted imaging MRI showed an ischemic area at the posterior arm of the right internal capsule and given that her clinical conditions were getting worse, it was decided, with obstetric back-up and according to recent indications, to treat her with IV rTPA (recombinant tissue plasminogen activator), in the absence of availability of the interventional neuroradiology unit in the area. Due to a previous premature delivery (28 weeks), she was at risk of bleeding and death. Therefore, after treatment, she was transported to another hospital with a neonatal intensive care unit. Results: The response was excellent and at the end of thrombolysis she was able to move the left side of her body. Our patient improved clinically with no residual deficits and there was no evidence of fetal injury following administration of rtPA on follow-up obstetrical evaluations. After 5 days, with a preterm delivery with a good outcome, she gave birth to a healthy baby. Conclusion: necessary and important physiologic changes are responsible for an increased risk of thrombotic complications during and after the pregnancy. Given that there are no specific trials, this case confirms once again that acute stroke treatment decision-making is a complex process that must be performed quickly. In this case, if the patient must be treated at a first level stroke center, transport to an advanced stroke center as a “drip and ship” has to become a standard. In the near future, with the current ongoing implementation of mechanical thrombectomy in routine practice, it is expected that more pregnant women will benefit from acute reperfusion strategies.
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