Spontaneous sternocleidomastoid muscle hematoma following thrombolysis for acute ischemic stroke.
Spontaneous or traumatic bleeding is a common complication of systemic thrombolysis in patients with acute ischemic stroke. We report the case of an 83 y.o. woman with right facio-brachio-crural hemiparesis, left deviation of the head and aphasia who developed, after thrombolytic therapy, a spontaneous sternocleidomastoid muscle hematoma that regressed few days later. To our knowledge, this is the first case reported in the literature of asymptomatic and spontaneous skeletal muscle hematoma following thrombolysis for the treatment of acute ischemic stroke. The occurrence of lateral cervical tuberculosis lymphadenitis ipsilateral to sternocleidomastoid muscle hematoma may suggest a causal relationship between local chronic inflammation of active mycobacterial infection and thrombolysis-related extravasation. This case should suggest caution in thrombolytic treatment in patients with chronic immune dysregulation and vascular inflammation such as extra-pulmonary tuberculosis.
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Nadia Mariagrazia
NM
Giannantoni
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Giacomo
G
Della Marca
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Aldobrando
A
Broccolini
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Fabio
F
Pilato
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Paolo
P
Profice
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Roberta
R
Morosetti
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy.
Pietro
P
Caliandro
Department of Neuroscience, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy. Electronic address: giovannifrisullo@rm.unicatt.it.
Giovanni
G
Frisullo
D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006406:Hematoma / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D009334:Neck Muscles / Q000503:physiopathology*; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D015898:Tomography Scanners, X-Ray Computed
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator