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KMID : 1150320160120020274
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Journal of Korean Society of Geriatric Neurosurgery
2016 Volume.12 No. 2 p.274 ~ p.278
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Remote Hemorrhage after Bridge Therapy in Acute Ischemic Stroke: A Case Report
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Shinn James Ki
Shim Yu-Shik
Hyun Dong-Keun
Park Hyeon-Seon
Oh Se-Yang
Kim Eun-Young
Yoon Seung-Hwan
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Abstract
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A 71 years old female visited the emergency room with complaint of left side weakness (Grade III) and dysarthria around 40 minutes later from the first abnormal time. On her visit, her initial NIHSS was 8 and there were no abnormal findings in brain computed tomography (CT). Intravenous thrombolysis was done by using 0.9mg/kg intravenous recombinant tissuetype plasminogen activator (IV-tPA) and acute stroke magnetic resonance image (MRI) was processed immediately. On magnetic resonance angiography (MRA) findings, there was right M1 total occlusion. Intra-arterial stent retrieval treatment was used to remove a certain amount of clot. Full recanalization of right middle cerebral artery (MCA) was confirmed via transfemoral angiography. Although intracerebral hemorrhage on the left frontal lobe on post procedure brain CT, her symptoms were improved since her left side weakness was checked as grade IV and NIHSS was 6. However, patient got worse with stuporous mentality and an increase of Intracerebral hemorrhage was found on the follow up CT after 3 hours from the end of procedure (after 7 hours from using IV tPA). On the result, craniotomy and hematoma removal was done. Her mental status was improved after surgery. In this case, remote hemorrhage could occur due to multiple embolisms which maybe result from cardiac problem such as atrial fibrillation.
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KEYWORD
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Thrombolysis, Intravenous recombinant tissue-type plasminogen activator (IV t-PA), Intracerebral hemorrhage
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