tPA

Tissue plasminogen activator or tPA may actually live up to its name as a miracle drug. It dissolves clots and is primarily used to treat acute ischemic stroke. An older gentleman with no significant past medical history has a witnessed change in mental status. He is eating with his daughter when he suddenly stops talking, "acts oddly," then falls to the ground. At that point, the daughter realizes he cannot move his left arm or leg. He is emergently brought into the emergency department. There, a head CT is negative for bleeding, and tPA is given. When I first meet the patient, the tPA has not yet had effect; the patient can only say his name and cannot move the left side of his body at all. He has a prominent facial droop and it is difficult to understand his speech.

Several hours later, after the clot is dissolved, I go see him. He tells me his name, the city, and gets the date right within a week. He wants "cerveza" and chocolate. Although his left side is still weaker than his right, he can grasp my hand and push his toes down reasonably hard. His left facial droop is nearly gone. Two days later, he goes home and soon will be back to tending his garden. After seeing the remarkable and dramatic neurologic improvement, I really gained a new awe for tPA.

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