title: Anterior communicating artery aneurysm rupture after intravenous thrombolysis for acute middle cerebral artery thromboembolism:  case report.
abstract: BACKGROUND
  The use of intravenous recombinant tissue plasminogen activator (IV rtPA) has become an integral part of modern acute ischemic stroke management; however, its use has been associated with the development of intracranial hemorrhage in 6.4% of patients. It is possible that underlying and unsuspected vascular lesions, such as cerebral aneurysms, may lead to intracranial hemorrhage after IV rtPA thrombolysis.
  
  
  METHODS
  We present a previously unreported case of a 51-year-old woman who presented with subarachnoid hemorrhage from an acutely ruptured anterior communicating artery aneurysm after IV rtPA treatment for acute left middle cerebral artery thromboembolism. The patient underwent mechanical thromboembolectomy of the left middle cerebral artery occlusion with resultant TIMI (Thrombolysis In Myocardial Infarction) grade I recanalization, followed by coil embolization of the anterior communicating artery aneurysm. The patient never improved neurologically, and she ultimately died.
  
  
  CONCLUSIONS
  Screening to identify patients at risk for development of hemorrhagic complications from underlying structural vascular lesions before the use of IV rtPA with computed tomography angiography should be considered.
authors.affiliation: Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine, Peoria, Illinois, USA. srammos.ani@stvincenthealth.com
authors.forename: Stylianos K
authors.initials: SK
authors.lastname: Rammos
authors.forename: David M
authors.initials: DM
authors.lastname: Neils
authors.forename: Kenneth
authors.initials: K
authors.lastname: Fraser
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klopfenstein
mesh_terms: D017542:Aneurysm, Ruptured / Q000139:chemically induced* / Q000628:therapy; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy*; D002532:Intracranial Aneurysm; D020767:Intracranial Thrombosis / Q000188:drug therapy; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator