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Updated: Aug 17, 2026

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Symptomatic hemorrhage after alteplase therapy not due to silent ischemia
M D Hill1, P A Barber, A M Demchuk
1Department of Clinical Neurosciences, University of Calgary, Stroke Research Office, Foothills Hospital, 1403 29th Street NW, Calgary, Alberta, Canada. michael.hill@crha-health.ab.ca
Background:
Stroke thrombolysis-related intracerebral hemorrhage may occur remotely from the anatomical site of ischemia. One postulated mechanism for this is simultaneous multiple embolization with hemorrhage into a "silent" area of ischemia.
Results:
A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem.
Conclusion:
Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.
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