Massive pontine hemorrhagic transformation associated with an anticoagulant for basilar artery occlusion.
Symptomatic hemorrhagic transformation is common in supratentorial and cerebellar infarction, but is rare in brainstem infarction. It is seldom reported in basilar artery occlusion. Although early arterial recanalization by thrombolytic agent has became the new trend of treatment, for some neurologists anticoagulant is still a conventional alternative treatment of basilar artery occlusion, especially in longer-existing ischemic deficits. We report a case of massive pontine hemorrhage associated with enoxaparin (low-molecular-weight heparin) treatment for basilar artery occlusion. On the basis of the clinical information and neuroimaging, an embolism was the most likely cause of stroke. The case presented herein adds massive pontine hemorrhagic transformation to the list of possible complications of anticoagulants for basilar artery occlusion. Apart from no evidence-based benefit in treatment of basilar artery occlusion, anticoagulant may contribute to devastating hemorrhagic transformation.
Hsiao
Ming-Chang
MC
Department of Neurology, Chang Gung Memorial Hospital, Chang Gung Institute of Technology, Chiayi County, Taiwan.
Lee
Jiann-Der
JD
Lee
Meng
M
Weng
Hsu-Huei
HH
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000473:pathology*; D017984:Enoxaparin / Q000009:adverse effects* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011149:Pons / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000188:drug therapy*
D000925:Anticoagulants; D017984:Enoxaparin