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Case Reports
. 2001 Dec 18:1:1.
doi: 10.1186/1471-2377-1-1. Epub 2001 Dec 18.

Symptomatic hemorrhage after alteplase therapy not due to silent ischemia

M D Hill  1 , P A Barber, A M Demchuk, R J Sevick, R Frayne, A M Buchan
Affiliations
Case Reports

Symptomatic hemorrhage after alteplase therapy not due to silent ischemia

M D Hill et al. BMC Neurol. .

Abstract

Background: Stroke thrombolysis-related intracerebral hemorrhage may occur remotely from the anatomical site of ischemia. One postulated mechanism for this is simultaneous multiple embolization with hemorrhage into a "silent" area of ischemia.

Results: A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem.

Conclusion: Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.

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Figures

Figure 1
Figure 1
Post-alteplase infusion (~ 230 min after stroke onset) diffusion weighted brain magnetic resonance image showing cortical infarct in the motor strip
Figure 2
Figure 2
Post-alteplase infusion (~ 230 min after stroke onset) diffusion weighted brain magnetic resonance image showing absence of any acute lesion in the brainstem.
Figure 3
Figure 3
6 h CT scan showing new pontomesencephalic hemorrhage.
See this image and copyright information in PMC

References

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