title: Paradoxically accelerated fatal brain herniation following thrombolytic therapy in acute ischemic stroke.
abstract: 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.
authors.affiliation: 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.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Han
authors.forename: Seo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Ha Young
authors.initials: HY
authors.lastname: Shin
authors.forename: Hye Yeon
authors.initials: HY
authors.lastname: Choi
authors.forename: Chan Hee
authors.initials: CH
authors.lastname: Park
authors.forename: Jin Kwon
authors.initials: JK
authors.lastname: Kim
authors.forename: Ji Hoe
authors.initials: JH
authors.lastname: Heo
mesh_terms: 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*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator