Thrombolysis for ischaemic stroke and glioblastoma multiforme: a case report

Abstract

Objective: To report the uncomplicated use of systemic thrombolysis for stroke in a patient with a misdiagnosed glioblastoma multiforme mimicking brain ischaemia and to suggest that new clinical situations question the stated exclusion criteria for intravenous thrombolysis.

Patient: A 57-year-old male presented at the emergency room with a sudden aphasia.

Measurement and main results: After Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) exclusion criteria were ruled out, intravenous alteplase was administered. The patient presented with tonic-clonic seizures 17 min after perfusion completion, requiring phenytoine administration. Additional computed tomography scan did not show haemorrhagic transformation or brain oedema. A left temporal lobe glioblastoma multiforme was diagnosed after magnetic resonance imaging and neurosurgery. The patient became asymptomatic on the seventh day.

Conclusion: Any history of central nervous system neoplasm is considered a contraindication to thrombolysis, but the true risk of systemic thrombolysis-precipitated intracranial bleeding is unknown. Further data are needed to establish real haemorrhage risk in this clinical condition.

Figure 1

A. Cranial computed tomography without contrast, previous to alteplase infusion. B. Coronal gadolinium enhanced T₁-weighted MRI. A very small glioblastoma multiforme could be diagnosed after stereotaxic biopsy.