Spinal epidural hematoma after intravenous thrombolysis for acute ischemic stroke.
Intracranial bleeding is an important and dangerous complication associated with thrombolytic therapy for acute ischemic stroke. Spinal hemorrhage has been reported after systemic thrombolysis for various conditions other than acute ischemic stroke. Our patient presented with an acute ischemic stroke and showed significant clinical recovery during intravenous thrombolysis. CT scan of the brain, performed about 6 h later due to neurological deterioration did not reveal any bleeding or a new infarction. However, an acute epidural hematoma was noted on MRI of the cervical spine. She was treated conservatively and showed a satisfactory recovery. We report, probably the first case of spinal epidural hemorrhage after systemic thrombolysis for acute ischemic stroke. Spinal hemorrhage should be considered as a differential diagnosis for neurological worsening after intravenous thrombolysis for acute ischemic stroke, especially when the brain imaging studies do not reveal an appropriate intracranial pathology.
Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore.
Leonard L L
LL
Yeo
Joline Si Jing
JS
Lim
Vijay K
VK
Sharma
D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy*; D020526:Brain Stem Infarctions / Q000150:complications; D002574:Cervical Vertebrae; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D046748:Hematoma, Epidural, Spinal / Q000139:chemically induced*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator