title: Successful use of Alteplase during cardiopulmonary resuscitation following massive PE in a patient presenting with ischaemic stroke and haemorrhagic transformation.
abstract: The management of patients with acute stroke regarding treatment of thromboembolism is supported by a limited evidence base. We present the case of a 55-year-old female patient who initially presented with an ischaemic cerebral infarct with haemorrhagic transformation. Her clinical recovery was complicated by cardiac arrest secondary to massive pulmonary embolism. This was successfully treated with cardiopulmonary resuscitation and thrombolysis using Alteplase, which led to a full recovery to the pre-arrest state with no evidence of haemorrhagic complication. The patient was successfully discharged to a specialist centre for on-going stroke rehabilitation with no additional neurological impact. Despite the limited evidence base we believe this case highlights that thrombolysis can be used in select patients with haemorrhagic transformation of stroke and serious thromboembolic complications to achieve a positive outcome.
authors.affiliation: Oxford University Hospitals NHS Trust, Banbury, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Middleton
authors.affiliation: Oxford University Hospitals NHS Trust, Banbury, UK.
authors.forename: Juliane
authors.initials: J
authors.lastname: Neumann
authors.affiliation: Oxford University Hospitals NHS Trust, Banbury, UK.
authors.forename: Simon Michael
authors.initials: SM
authors.lastname: Ward
mesh_terms: D016887:Cardiopulmonary Resuscitation; D002544:Cerebral Infarction / Q000209:etiology; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006470:Hemorrhage; D006801:Humans; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy*; D020521:Stroke / Q000209:etiology*; D013923:Thromboembolism / Q000150:complications / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator