American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2021, 9(12), 739-742
DOI: 10.12691/ajmcr-9-12-20
Open AccessArticle

Thrombolytic Associated Pontine Hemorrhage in a Stroke Patient

Stella Onyi1, Chukwuemeka A. Umeh2, and Frederick White1

1Department of Diagnostic Radiology, Hemet Global Medical Center, California USA

2Department of Internal Medicine, Hemet Global Medical Center, California USA

Pub. Date: October 18, 2021

Cite this paper:
Stella Onyi, Chukwuemeka A. Umeh and Frederick White. Thrombolytic Associated Pontine Hemorrhage in a Stroke Patient. American Journal of Medical Case Reports. 2021; 9(12):739-742. doi: 10.12691/ajmcr-9-12-20

Abstract

Stroke is a leading cause of disability and death, and the use of tissue plasminogen activator (tPA) has been shown to improve outcomes in ischemic stroke. However, despite the favorable outcome from the use of tPA, it has been associated with complications, including intracranial hemorrhage, major systemic hemorrhage, and angioedema. Though there are few reports of intracerebral hemorrhage complicating tPA use, pontine hemorrhage, a sub-set of intracerebral hemorrhage, is rarely reported. We report a case of pontine hemorrhage in an ischemic stroke patient after tPA and discussed the management of this rare complication of tPA.

Keywords:
stroke CVA tissue plasminogen activator pontine hemorrhage intracerebral hemorrhage

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References:

[1]  CDC. Stroke facts. Accessed on June 18, 2021 from https://www.cdc.gov/stroke/facts.htm.
 
[2]  Furlan A, Higashida R, Wechsler L, et al. Intra-arterial prourokinase for acute ischemic stroke: the PROACT II study: a randomized controlled trial. Jama. 1999 Dec 1; 282(21): 2003-11.
 
[3]  Meyers PM, Schumacher HC, Connolly Jr ES, Heyer EJ, Gray WA, Higashida RT. Current status of endovascular stroke treatment. Circulation. 2011 Jun 7; 123(22): 2591-601.
 
[4]  Miller DJ, Simpson JR, Silver B. Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies. The Neurohospitalist. 2011 Jul; 1(3): 138-47.
 
[5]  Mehta RH, Cox M, Smith EE, et al. Race/Ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy. Stroke. 2014 Aug; 45(8): 2263-9.
 
[6]  Brown DL, Barsan WG, Lisabeth LD, Gallery ME, Morgenstern LB. Survey of emergency physicians about recombinant tissue plasminogen activator for acute ischemic stroke. Annals of emergency medicine. 2005 Jul 1; 46(1): 56-60.
 
[7]  Broderick J, Connolly S, Feldmann E, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage in Adults: 2007 Update: A Guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007 Jun 1; 38(6): 2001-23.
 
[8]  Goldstein JN, Marrero M, Masrur S, et al. Management of thrombolysis-associated symptomatic intracerebral hemorrhage. Archives of neurology. 2010 Aug 1; 67(8): 965-9.
 
[9]  Wijdicks EF, Louis ES. Clinical profiles predictive of outcome in pontine hemorrhage. Neurology. 1997 Nov 1; 49(5): 1342-6.
 
[10]  Sloan MA, Sila CA, Mahaffey KW, et al. Prediction of 30-day mortality among patients with thrombolysis-related intracranial hemorrhage. Circulation. 1998 Oct 6; 98(14): 1376-82.
 
[11]  Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993 Jul; 24(7): 987-93.
 
[12]  Balci K, Asil T, Kerimoglu M, Celik Y, Utku U. Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage. Clinical neurology and neurosurgery. 2005 Dec 1; 108(1): 36-9.