title: An early successful surgical treatment of fibrinolysis-related symptomatic intracerebral hemorrhage without procoagulant therapy.
abstract: Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is clinically effective at treating acute ischemic stroke. However, the use of thrombolytic therapy is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH). Whether unacceptable surgical hemorrhage occurs after emergent decompressive craniotomy during the first hours for sICH remains unknown. We report a 69-year-old Chinese woman with a fibrinolysis-related sICH, and discuss the efficacy and the safety of craniotomy in this setting. An urgent decompressive craniotomy was performed through a standard pterional approach without any procoagulant therapy before operation. No unacceptable surgical hemorrhage occurred during the first hours after onset of sICH, and the outcome of this patient is fairly good. Early urgent decompressive craniectomy in the treatment of fibrinolysis-related sICH may be a safe therapy, which may improve clinical outcomes.
authors.affiliation: Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Yang
authors.forename: Chunxia
authors.initials: C
authors.lastname: Luo
authors.forename: Hongping
authors.initials: H
authors.lastname: Miao
authors.forename: Zhi
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000601:surgery; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000601:surgery*; D056424:Decompressive Craniectomy / Q000379:methods*; D005260:Female; D006801:Humans; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed / Q000379:methods