title: Intracerebral hemorrhage after intravenous thrombolysis in patients with cerebral microbleeds and cardiac myxoma.
abstract: OBJECTIVE
  Cardiac myxoma is a rare etiology of stroke. Both cerebral microbleeds and cardiac myxoma may increase the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis. However, data are still limited. We report a case of multiple cerebral microbleeds treated with IV thrombolysis with later findings of cardiac myxoma.
  
  
  METHODS
  A 58-year-old-man presented with right-sided hemiplegia and global aphasia. The presumptive diagnosis of acute left middle cerebral artery (MCA) infarction was made. Previous magnetic resonance imaging showed multiple cerebral microbleeds. The patient received IV thrombolysis. Bilateral cerebellar hemorrhage occurred after thrombolysis, and a median suboccipital craniectomy and hematoma removal was performed. Transthoracic echocardiogram found a left atrial myxoma. The tumor was then surgically removed. Six months later, neurological deficit improved.
  
  
  CONCLUSIONS
  Cerebral microbleeds may be associated with atrial myxoma. IV thrombolysis could benefit acute ischemic stroke patients with both baseline cerebral microbleeds and atrial myxoma.
authors.affiliation: Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand.
authors.forename: Aurauma
authors.initials: A
authors.lastname: Chutinet
authors.affiliation: Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand ; Faculty of Medicine, Department of Medicine, Naresuan University , Phitsanulok , Thailand.
authors.forename: Duangnapa
authors.initials: D
authors.lastname: Roongpiboonsopit
authors.affiliation: Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand.
authors.forename: Nijasri C
authors.initials: NC
authors.lastname: Suwanwela
keywords: cardiac myxoma; microbleeds; recanalization; thrombolysis