title: Decompressive craniectomy after unsuccessful intravenous thrombolysis of malignant cerebral infarction.
abstract: BACKGROUND
  Intravenous recombinant tissue plasminogen activator (rt-PA) is an approved treatment for acute ischemic stroke within 4.5 h of symptoms onset. Decompressive craniectomy (DC) has been shown as an effective therapeutic modality in malignant middle cerebral artery (MCA) infarction. As rt-PA could result in hemorrhagic complication during or after any surgery DC may be associated with severe bleeding after intravenous thrombolysis.
  
  
  METHODS
  A 57-year-old woman was presented 90 min after the sudden onset of left hemiplegia. Despite intravenous thrombolytic therapy, she lost consciousness within 48 h and brain CT scan showed a right malignant MCA infarction associated with a small bleeding. DC was performed without any complication. The patient improved dramatically.
  
  
  CONCLUSIONS
  DC could be done safety for malignant MCA infarction after unsuccessful intravenous thrombolytic therapy even the later was complicated with intra-infarction hemorrhage.
authors.affiliation: Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Humain
authors.initials: H
authors.lastname: Baharvahdat
authors.affiliation: Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Hamid
authors.initials: H
authors.lastname: Etemadrezaie
authors.affiliation: Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Samira
authors.initials: S
authors.lastname: Zabyhian
authors.affiliation: Neurology Research Group, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Valipour
authors.affiliation: Department of Neurosurgery, School of Medicine, Emdadi Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Babak
authors.initials: B
authors.lastname: Ganjeifar
authors.affiliation: Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Seyed Mohammad
authors.initials: SM
authors.lastname: Mousavi Mirzaye
authors.affiliation: Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Payam
authors.initials: P
authors.lastname: Sasannejad
authors.affiliation: Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: Kavian
authors.initials: K
authors.lastname: Ghandehari
keywords: Cerebral Infarction; Decompressive Craniectomy; Ischemic Stroke; Thrombolysis