Case report Cerebral hemorrhage after systemic fibrinolysis in a patient with severe carotid artery stenosis

Abstract

Despite the beneficial effect of systemic fibrinolysis in treatment within 3 hours from ischemic stroke onset, the unpredicted occurrence of intracerebral hemorrhage remains a risk from such therapy. Few data exist defining patients at risk for this outcome. We report clinical and neuropathological data on a patient fulfilling NINDS rt‐PA study and ECASS‐2 inclusion criteria with an acute stroke due to high‐grade carotid artery stenosis and preceded by amaurosis fugax. He died from an intracerebral hemorrhage after systemic fibrinolysis. The fatal outcome adds support to recommendations that rapid Doppler‐sonographic evaluation of the extra‐ and intracranial vascular status be undertaken before systemic rt‐PA is implemented in acute ischemic stroke.