title: Use of intralesional tPA in spontaneous intracerebral hemorrhage: retrospective analysis.
abstract: BACKGROUND
  Neurosurgical treatment of spontaneous intracerebral hemorrhage (ICH) is controversial, with a lack of evidence-based guidelines contributing to the high variety of treatments. In our study we examine the outcome and complication from use of intralesional tissue plasminogen activator (IL tPA).
  
  
  METHODS
  Patients who have been treated with IL tPA for spontaneous ICH were reviewed retrospectively. We compared clot sizes before and after tPA infusion, and outcome based on the modified Rankin score.
  
  
  RESULTS
  Nine patients received IL tPA during the period 1999-2009. No immediate complications with use of IL tPA were found. There was a statistically significant volume reduction in clot sizes on computed tomography. Four patients recovered to independent functional status. Three patients were discharged to SNF, and two patients died as a result of ICH. Our results appear to demonstrate superior outcome to supportive management and no worse result than surgical management.
  
  
  CONCLUSIONS
  It appears a subset of ICH patients benefits from use of IL tPA. This study demonstrates that IL tPA use is safe and has the potential to improve outcome compared to conservative management without the risk of surgical complications. Our patient size is small, and larger prospective studies are needed to provide solid guidelines for management of ICH.
authors: Department of Neurosurgery, Loma Linda University, School of Medicine, Loma Linda, CA 92350, USA. wjohnson@llu.edu
authors: Walter D
authors: WD
authors: Johnson
authors: Peter A
authors: PA
authors: Bouz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator