Abstract
This is a case of a 90-year-old-female with diagnosed atrial fibrillation who was admitted to our hospital suffering from right hemiparalysis and aphasia. The initial NIH Stroke Scale (NIHSS) score was 25 points. On diffusion-weighted imaging (DWI), a diffuse high intensity area was detected in the left insular cortex. Intravenous thrombolysis using tissue plasminogen activator (rt-PA, 40 kg, 24 mg) was administered within 3 hours (1 hour and 45 minutes) of symptom onset, which was caused by acute embolic cerebral infarction. After this treatment, her motor weakness and NIHSS score were improved by 17 points within 1 hour and 30 minutes. However, just after, she suddenly went into shock (maximal blood pressure was 60 mmHg) and into a coma. On head and whole-body CT scans, no intracranial hemorrhage was detected, but a large volume of pericardial effusion resulting in cardiac tamponade was detected. She died 3 hours and 35 minutes after treatment, and a pathological autopsy was performed. The autopsy showed a recent myocardial infarction and a blow-out-type of cardiac rupture of the posterior wall of the left ventricular. We should be alert to fatal cardiac complications of rt-PA treatment for patients with concomitant stroke and myocardial infarction.
