Thrombolytic therapy in stroke-related trauma

Trauma and/or evidence of nonintracranial bleeding is a relative contraindication for thrombolytic therapy in acute stroke. The aim of this study was to determine the incidence and nature of stroke-related trauma and its influence on treatment of patients.

Patients with stroke-related trauma were identified among all acute-stroke patients protocoled for intravenous/intraarterial thrombolytic therapy during a two-year period (6/01-5/03). The history and physical examination along with imaging findings and hospital records of these patients were reviewed.

Six patients with stroke-related trauma were identified among 520 protocoled patients. In three, trauma resulted from a fall due to stroke and in three, trauma resulted from a motor vehicle crash due to stroke. Two from the former group sustained fracture (one each wrist and hip) and one from the latter group sustained fracture (sternum) with soft-tissue injury alone in the remaining three. Three of the six stroke-related trauma patients were excluded from consideration of thrombolytic therapy.

Stroke-related trauma occurred equally from fall and motor vehicle crash in six of 520 patients protocoled for thrombolytic therapy, three with soft-tissue injury alone and three soft-tissue injury and fracture. Three of the six were inappropriately excluded from consideration of thrombolytic therapy.