Introduction: The indications for intravenous thrombolysis for acute ischemic stroke have been expanded after the publication of the NINDS trial in 1995, using ages 18 to 80 as inclusion criteria. There are multiple reports of patients older than 80 treated with intravenous thrombolysis, and we are describing one of the oldest cases treated.

107 year old woman originally from the Dominican Republic (age confirmed after reviewing original documents including her passport) with history of hypertension, hyperlipidemia, diabetes, CAD, history of stroke 10 years earlier with mild right-sided residual deficits, and mild dementia , who collapsed while in the bathroom and was found then to have left sided weakness with left facial droop. NIHSS score was 14. The patient was given IV TPA 2 hours after symptom onset. CTA showed right ICA occlusion and severe stenosis of the left ICA, without significant intracranial occlusion/stenoses, and she was not considered endovascular treatment candidate. Brain MRI showed an acute right hemispheric, posterior parietal / occipital, ischemic stroke in the right posterior MCA / PCA territory. Her left-sided deficits had improved by the next day and the patient was discharged home four days later, able to walk with a walker. She was doing well when seen 4 months later.

Conclusion: The expansion of the criteria for the use of intravenous thrombolysis in acute ischemic stroke has shuttered the upper age limit. In otherwise appropriate candidates no maximum age limit should exist.

Intravenous tpa in the oldest old: a successful case of a 107 year old