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Abraham Totah, MD

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The article by Ozdemir et al¹ sheds light on important questions with which we struggle in treating patients with ischemic stroke. The administration of recombinant tissue plasminogen activator (rtPA) according to standard protocols frequently excludes patients who might benefit from such treatment. It is estimated that only 3% to 8% of eligible patients with ischemic stroke receive rtPA.² Studies that expand the use of rtPA hold promise for increasing that percentage.

All of the patients studied by Ozdemir and colleagues were treated within the therapeutic time window of intravenous or intra-arterial rtPA administration. Violating the therapeutic time window in patients with fluctuating symptoms has not been discussed. As an example of such a situation, I would like to share the following case.

A 60-year-old woman had a recurrent small-vessel syndrome with complete right hemiplegia and dysarthria. The deficit resolved on presentation but recurred 3 times in the . . . [Full Text of this Article]

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RELATED ARTICLE

Thrombolysis in Patients With Marked Clinical Fluctuations in Neurologic Status Due to Cerebral Ischemia
Ozcan Ozdemir, Vadim Beletsky, Richard Chan, and Vladimir Hachinski
Arch Neurol. 2008;65(8):1041-1043.
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RELATED LETTER

Thrombolysis, Fluctuations, and Protocol Expansions—Reply
Ozcan Ozdemir, Vadim Beletsky, Richard Chan, and Vladimir Hachinski
Arch Neurol. 2009;66(3):418-419.
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