title: Perfusion imaging in the 3-hour time window predicts a tPA-associated hemorrhage in acute ischemic stroke.
abstract: Perfusion imaging is being evaluated in acute ischemic stroke patients to identify those who may benefit from reperfusion therapies beyond the standard thrombolytic time window but limited data are available on its utility in patients presenting within the standard thrombolytic time window. We report a case of a patient presenting within the 3-hour time window where computerized tomographic perfusion imaging before intravenous thrombolysis identified a large volume of severely ischemic tissue and where intravenous tissue plasminogen activator administration subsequently resulted in a fatal intracerebral hemorrhage. Whether perfusion imaging can predict an increased risk of tissue plasminogen activator-associated symptomatic hemorrhage in patients presenting within the standard thrombolytic time window requires further study.
authors.affiliation: Departments of *Neurology †Radiology, Emory University, Atlanta, GA.
authors.forename: Srikant
authors.initials: S
authors.lastname: Rangaraju
authors.forename: Adam
authors.initials: A
authors.lastname: Edwards
authors.forename: Seena
authors.initials: S
authors.lastname: Dehkharghani
authors.forename: Fadi
authors.initials: F
authors.lastname: Nahab
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D055420:Perfusion Imaging / Q000379:methods*; D011379:Prognosis; D020521:Stroke / Q000000981:diagnostic imaging*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000032:analysis*
chemical_list: D010959:Tissue Plasminogen Activator