Fatal intracranial aneurysm rupture after thrombolytic treatment for ischemic stroke: a case report and literature review

Acta Neurochir (Wien). 2019 Jul;161(7):1337-1341. doi: 10.1007/s00701-019-03931-3. Epub 2019 May 7.

Abstract

Intravenous thrombolysis is a proven treatment of acute ischemic stroke. Its complications include intracranial hemorrhage; the risk may be increased in the presence of an unruptured aneurysm. We present a case report of a patient who suffered fatal subarachnoid hemorrhage after thrombolysis from a known aneurysm. A history of recent previously inexperienced headaches was revealed retrospectively, suggestive of sentinel bleedings. A similar patient was identified in the literature; we thus propose that this history should be excluded in patients harboring an aneurysm considered for thrombolytic treatment.

Keywords: Aneurysm; Outcome; Stroke; Subarachnoid hemorrhage; Thrombolysis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aneurysm, Ruptured / chemically induced*
  • Brain Ischemia / drug therapy*
  • Fatal Outcome
  • Fibrinolytic Agents / adverse effects*
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Intracranial Aneurysm / chemically induced*
  • Male
  • Retrospective Studies
  • Stroke / drug therapy*
  • Thrombolytic Therapy / adverse effects*
  • Tissue Plasminogen Activator / adverse effects*
  • Tissue Plasminogen Activator / therapeutic use

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator