title: Intravenous tissue plasminogen activator for an ischemic stroke with occult double primary cancer.
abstract: BACKGROUND
  In patients with advanced-stage cancer, systemic thrombolysis with tissue plasminogen activator (tPA) for hyperacute ischemic stroke is not strictly off-label, but it is at higher risk of complications (including bleeding).
  
  
  METHODS
  A 71-year-old male with unrecognizable malignancy developed a hemispheric ischemic stroke and received intra-venous tPA within 4.5 h of onset, followed by anticoagulation treatment after 24 h of throm-bolysis. Two days later, the patient had tarry stool and progressive anemia, receiving a blood transfusion. The systemic workup documented the presence of double primary cancers with advanced stage gastric and rectal cancers, and the patient subsequently received palliative care. The outcome at 3 months was a modified Rankin Scale of 5, and the patient died 6 months after the stroke.
  
  
  CONCLUSIONS
  Although systemic thrombolysis with tPA for ischemic stroke in patients with advanced-stage cancer may be performed relatively safely, optimal post-thrombolysis management is important to prevent the complications.
authors.affiliation: Division of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yoneda
authors.affiliation: Division of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fukuda
authors.affiliation: Division of Gastroenterology, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Yamazaki
authors.affiliation: Neurosurgery, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Natsuhi
authors.initials: N
authors.lastname: Sasaki
authors.affiliation: Division of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ohta
authors.affiliation: Division of Gastroenterology, Hyogo Prefectural Amagasaki Hospital, Amagasaki City, Japan.
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kageyama
keywords: Cancer; Ischemic stroke; Stroke; Thrombolysis