title: Thrombolysis for ischemic stroke in patients with brain tumors.
abstract: BACKGROUND
  Thrombolysis is the most successful therapy in acute ischemic stroke. Limitations comprise strict eligibility criteria including many contraindications for thrombolysis, and in particular clinical situations lack of evidence-based data resulting in recommendations based on single experiences. Therefore, the risk-benefit effect of thrombolysis in the presence of brain tumor is unknown.
  
  
  METHODS
  We conducted a systematic literature research of electronic databases (MEDLINE, Goggle Scholar) covering the period from 1990 to 2012 including search terms "thrombolysis," "stroke," "brain tumor," and "intracranial neoplasm." In addition, we report 1 new case of a 71-year-old patient with a large right frontal meningioma who fully recovered with thrombolysis from a severe ischemic stroke.
  
  
  RESULTS
  Our literature research retrieved 12 patients with different brain tumors who were treated with thrombolysis for different reasons. Intracerebral hemorrhage occurred in 1 patient (8.3%) with a glioblastoma, and in the other 11 patients (91.7%), no hemorrhage was documented. In the subgroup of 8 stroke patients, both patients with a glioblastoma had no stroke but rather a focal seizure. Two of 3 patients with meningiomas showed a very good benefit from thrombolysis.
  
  
  CONCLUSIONS
  In summary, very limited data exist about thrombolysis in patients with brain tumors. Differentiation of tumor by additional neuroimaging before thrombolysis in ischemic stroke is recommended as thrombolysis might be considered in extra-axial benign appearing neoplasms (eg, meningioma) but is not advisable in intra-axial primary or metastatic neoplasm. Further reporting of thrombolysis in patients with brain tumors is recommended.
authors.affiliation: Department of Neurology, Kliniken Südostbayern-Klinikum Traunstein, Traunstein, Germany; Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany. Electronic address: thorleif.etgen@klinikum-traunstein.de.
authors.forename: Thorleif
authors.initials: T
authors.lastname: Etgen
authors.affiliation: Department of Neurology, Kliniken Südostbayern-Klinikum Traunstein, Traunstein, Germany.
authors.forename: Ines
authors.initials: I
authors.lastname: Steinich
authors.affiliation: Department of Neurology, Kliniken Südostbayern-Klinikum Traunstein, Traunstein, Germany.
authors.forename: Lukas
authors.initials: L
authors.lastname: Gsottschneider
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Thrombolysis; hemorrhage-brain tumor; ischemic stroke