Fatal streptokinase-induced intracerebral haemorrhage in cerebral amyloid angiopathy.
A fatal intracerebral haemorrhage (ICH) associated with streptokinase (SK) treatment of an acute myocardial infarction is described. Autopsy examination showed a lobar ICH and severe cerebral amyloid angiopathy (CAA). The close temporal relationship between SK administration and intracranial haemorrhage, the absence of pretreatment risk factors for ICH, and the presence of CAA suggests that these are related phenomena. Accordingly: 1. There may be a synergistic relationship between CAA and intracranial haemorrhage induced by fibrinolytic agents; 2. Thrombolytic agents may induce more frequent than expected intracranial haemorrhage in conditions associated with a high incidence of CAA, notably old age and Alzheimer's disease; 3. A regional defect in haemostasis other than vessel fragility may contribute to the intracranial haemorrhagic predisposition of CAA; 4. Autopsy examination of cases of ICH is an essential part of the audit of clinical trials of fibrinolytic agents.
Ramsay
D A
DA
Department of Pathology, Queen's University, Kingston, Ontario, Canada.
Penswick
J L
JL
Robertson
D M
DM
D000686:Amyloidosis / Q000503:physiopathology*; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000150:complications / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D012307:Risk Factors; D013300:Streptokinase / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D013300:Streptokinase