title: Catastrophic Intracranial Hemorrhages after IV tPA in a Patient with Insidious Onset of Fever and Back Pain.
abstract: Infective endocarditis is associated with unstable infective vegetations, which have a propensity to embolize and cause embolic events, such as stroke. Many cases present with an embolic event as the first sign of infective endocarditis. We present a patient who had a history of recent and persistent fever, an acute ischemic stroke treated with intravenous tissue plasminogen activator (IV tPA), and severe, multifocal intracerebral hemorrhage as a complication of tPA treatment. Suspected infective endocarditis in a stroke patient should most likely be considered a contraindication to IV tPA.
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Tversky
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York. Electronic address: rlibman@nshs.edu.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Libman
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Evan R
authors.initials: ER
authors.lastname: Schloss
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Rohan
authors.initials: R
authors.lastname: Arora
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Anand V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Salamon
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Wright
authors.affiliation: Department of Neurology, Cushing Neuroscience Institute, North Shore University Hospital, Northwell Health, Manhasset, New York.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Katz
mesh_terms: D001416:Back Pain / Q000175:diagnosis / Q000209:etiology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D002388:Catastrophic Illness; D002533:Cerebral Angiography / Q000379:methods; D000072226:Computed Tomography Angiography; D000075202:Contraindications; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis; D005334:Fever / Q000175:diagnosis / Q000209:etiology*; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; endocarditis; infectious disease; septic emboli; tPA