title: Rupture of a concealed aneurysm after intravenous thrombolysis of a thrombus in the parent middle cerebral artery.
abstract: BACKGROUND
  Management of ischemic stroke in the presence of aneurysmal brain disease is controversial. Recent retrospective evidence suggests that in selected patients, intravenous thrombolysis (IVT) remains a safe approach for reperfusion.
  
  
  METHODS
  We document a case of post-thrombolysis aneurysmal rupture. Supported by additional scientific literature we postulate that acute aneurysmal thrombosis leading to stroke in the culprit artery may be an ominous sign of rupture and should be considered separately from fortuitously discovered distant aneurysmal disease.
  
  
  RESULTS
  A 71-year-old female presented with an acute right middle cerebral artery stroke syndrome. IVT allowed vessel reperfusion and revealed a previously concealed, juxtaposed non-giant M1 segment saccular aneurysm. Secondary aneurysmal rupture ensued. The aneurysm was secured by surgical clipping. Postoperative course was uneventful.
  
  
  CONCLUSIONS
  This case shows that despite reports of thrombolysis safety in the presence of brain aneurysms, thrombolysis remains potentially hazardous and hints toward an increased risk when the stroke arises on the parent vessel itself.
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland. Electronic address: julien-francisco.zaldivar@chuv.ch.
authors.forename: Julien Francisco
authors.initials: JF
authors.lastname: Zaldivar-Jolissaint
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Messerer
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Bervini
authors.affiliation: Service de Radiologie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Pascal J
authors.initials: PJ
authors.lastname: Mosimann
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Levivier
authors.affiliation: Service de Neurochirurgie, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Roy Thomas
authors.initials: RT
authors.lastname: Daniel
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D020767:Intracranial Thrombosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D055420:Perfusion Imaging; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
keywords: Stroke; aneurysm; subarachnoid hemorrhage; thrombolysis