title: Successful intra-arterial thrombolysis in a patient with an intracranial meningioma.
abstract: Alteplase (recombinant tissue plasminogen activator [rt-PA]) label approval by the Food and Drug Administration remarks the contraindication of its use with known intracranial neoplasm because of potential bleeding complications. Despite this concern, the real risk of intracerebral bleeding in patients with intracranial neoplasms treated with rt-PA is unknown, and there are few reports of thrombolysis in patients with brain tumors. We report a case of a 78-year-old man who was seen in our emergency department within 2 hours from sudden onset of aphasia, right-sided hemiplegia, hypoesthesia, and homonymous hemianopsia. The National Institutes of Health Stroke Scale (NIHSS) score at admission was 20. Intra-arterial thrombolysis was performed with administration of .3 mg/kg of alteplase combined with mechanical thrombectomy. At discharge, his NIHSS score was 1, and after 90 days, his modified Rankin score was 1. To our knowledge, this is the first report of intra-arterial thrombolysis in a patient with acute ischemic stroke with an intracranial tumor.
authors.affiliation: Hospital do Coração, São Paulol, Brazil; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Robson F
authors.initials: RF
authors.lastname: Baiense
authors.forename: Agessandro
authors.initials: A
authors.lastname: Abrahão
authors.forename: Irapuá F
authors.initials: IF
authors.lastname: Ricarte
authors.forename: Thiago G
authors.initials: TG
authors.lastname: Fukuda
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Oliveira
authors.forename: Gisele S
authors.initials: GS
authors.lastname: Silva
authors.forename: Maristela
authors.initials: M
authors.lastname: Costa
authors.forename: Manoel J
authors.initials: MJ
authors.lastname: Teixeira
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D004185:Disability Evaluation; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications* / Q000175:diagnosis; D008579:Meningioma / Q000150:complications* / Q000175:diagnosis; D012720:Severity of Illness Index; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Intra-arterial thrombolysis; acute ischemic stroke; intracranial hemorrhage; intracranial neoplasm; mechanical thrombectomy; meningioma