title: Symptomatic hemorrhage after alteplase therapy not due to silent ischemia.
abstract: BACKGROUND
  Stroke thrombolysis-related intracerebral hemorrhage may occur remotely from the anatomical site of ischemia. One postulated mechanism for this is simultaneous multiple embolization with hemorrhage into a "silent" area of ischemia.
  
  
  RESULTS
  A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem.
  
  
  CONCLUSIONS
  Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.
authors.affiliation: Department of Clinical Neurosciences, University of Calgary, Stroke Research Office, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta, Canada. michael.hill@crha-health.ab.ca
authors.forename: M D
authors.initials: MD
authors.lastname: Hill
authors.forename: P A
authors.initials: PA
authors.lastname: Barber
authors.forename: A M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: R J
authors.initials: RJ
authors.lastname: Sevick
authors.forename: R
authors.initials: R
authors.lastname: Frayne
authors.forename: A M
authors.initials: AM
authors.lastname: Buchan
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D020521:Stroke / Q000150:complications* / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator