A case of intracerebral hemorrhage at the site of cerebral microbleeds after IV rt-PA thrombolysis for cerebral infarction

Abstract

An 83 year-old man with dementia of Alzheimer’s type suddenly developed right hemiplegia and global aphasia. NIHSS score was 19. Diffusion-weighted MRI demonstrated high-signal lesions in the left insula and corona radiata. T2* MRI showed a cerebral microbleed (CMB) in the right occipital white matter. Cardiogenic cerebral embolism was diagnosed. A thrombolytic therapy using intravenous rt-PA was performed 125 min after the onset without neurological improvement. CT immediately after the treatment revealed intracerebral hemorrhage at the site of CMB. In case of a subject with advanced age and subcortical CMB on T2* MRI, IV rt-PA thrombolysis should be carefully applied.