Fatal remote cerebral hemorrhage at a site of a microbleed immediately after intravenous thrombolysis

Abstract

AbstractWe report a patient with ischemic stroke who was treated with intravenous alteplase and subsequently developed a fatal pontine hemorrhage during cerebral angiography. An 88‐year‐old woman presented with right hemiplegia and aphasia. Magnetic resonance angiography at onset showed occlusion of the left middle cerebral artery. T2*‐weighted magnetic resonance imaging showed a cerebral microbleed in the pons. She was treated with intravenous alteplase followed by cerebral angiography. Left carotid angiography showed recanalization of the left middle cerebral artery, and neurointervention was not carried out. During the angiography, she became comatose. Computed tomography showed a massive pontine hemorrhage. The hemorrhage was considered to be attributable to the microbleed. The variety of time phases of cerebral microbleeds have been elucidated; there are a subset of lesions reflecting acute or subacute microhemorrhages. It is considered that expansion of a pontine microbleed induced by alteplase caused a fatal remote cerebral hemorrhage in the present case.