Abstract
A 95-year-old woman who exhibited drowsiness, anosognosia, left facial palsy and left hemiparesis with sensory loss was transferred to our institution 30 minutes after onset. Her NIHSS score was 14 and cranial computed tomography (CT) showed neither high density area nor early CT findings. Except for relative precautions (high age, prior ischemic stroke and use of aspirin), the clinical information indicated that intravenous rt-PA therapy (IVtPA) would be appropriate. When the therapy was started 70 minutes after the stroke onset, neurological deficits rapidly improved, and magnetic resonance diffusion weighted images showed a small localized infarction in the right parietal lobe. Clinical conditions were stable until she developed headache and vomiting 15 hours after IVtPA. Emergent CT revealed bilateral hematomas in the cerebellar hemispheres and subsequently a ventricular drainage was performed. Her clinical conditions gradually improved, but she died of congestive heart failure on day 52. As one of the complications after IVtPA, extraischemic cerebral hematomas occur in the brain region without visible ischemic damage that is remote from an ischemic infarct. Although this kind of hemorrhage is an infrequent complication, the outcome is quite unfavorable. Therefore, care of such complications should be taken when considering thrombolytic therapy for very elderly patients.
