Cerebral hemorrhage post tPA thrombolysis

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Acute right hemiplegia treated within 3 hours by IV tPA. Marked worsening of hemiplegia and reduced conscious state about 6 hours later.

Patient Data

Age: 70 years
Gender: Male

CTB performed within 1 hour...

ct

CTB performed within 1 hour of hemiplegia onset at 9.00am

Hyperdense right MCA without loss of grey white differentiation. No hemorrhage could be seen.

CT - 600pm after tPA injection

ct

Large right cerebral hematoma with intraventricular extension. Hyperdense R MCA is no longer present.

Case Discussion

Although tPA (tissue plasminogen activator) thrombolysis can lead to substantial clinical improvement in MCA occlusion there is always a risk of hemorrhage

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