Paradoxically accelerated fatal brain herniation following thrombolytic therapy in acute ischemic stroke.
BACKGROUND
The use of plasminogen activators (PAs) in acute stroke patients has dual effects. PAs are beneficial by dissolving thrombi occluding an artery, but may be harmful by their proteolytic and excitotoxic actions.


RESULTS
We report two patients with a fatal brain herniation who rapidly deteriorated despite the successful recanalization and the sustained arterial patency or blood flow. Imaging studies taken after the thrombolytic treatment suggested early occurrence of cellular damage and profound breakdown of the blood-brain barrier.


CONCLUSIONS
Fatal brain edema occurred after persistent reperfusion by the thrombolytic therapy. Paradoxical thrombolytic-induced injury, which has been suggested in experimental studies, might play a role.
Han
Sang Won
SW
Department of Neurology, National Core Research Center for Nanomedical Technology, Brain Korea 21 Project for Medical Sciences, Yonsei University College of Medicine, Seodaemoon-ku, Seoul, Korea.
Kim
Seo Hyun
SH
Shin
Ha Young
HY
Choi
Hye Yeon
HY
Park
Chan Hee
CH
Kim
Jin Kwon
JK
Heo
Ji Hoe
JH
D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy*; D016893:Carotid Stenosis / Q000188:drug therapy; D002533:Cerebral Angiography; D004677:Encephalocele / Q000175:diagnosis / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007269:Injections, Intra-Arterial; D020768:Middle Cerebral Artery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator