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Thrombolysis for ischaemic stroke and glioblastoma multiforme: a case report
Ana M Garcia1, Jose A Egido, Maria E Garcia
1Hospital Clinico Universitario San Carlos, Stroke Unit, Avda Martin Lagos, Madrid, 28040, Spain.
Objective:
To report the uncomplicated use of systemic thrombolysis for stroke in a patient with a misdiagnosed glioblastoma multiforme mimicking brain ischaemia and to suggest that new clinical situations question the stated exclusion criteria for intravenous thrombolysis.
Patient:
A 57-year-old male presented at the emergency room with a sudden aphasia.
Measurement And Main Results:
After Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) exclusion criteria were ruled out, intravenous alteplase was administered. The patient presented with tonic-clonic seizures 17 min after perfusion completion, requiring phenytoine administration. Additional computed tomography scan did not show haemorrhagic transformation or brain oedema. A left temporal lobe glioblastoma multiforme was diagnosed after magnetic resonance imaging and neurosurgery. The patient became asymptomatic on the seventh day.
Conclusion:
Any history of central nervous system neoplasm is considered a contraindication to thrombolysis, but the true risk of systemic thrombolysis-precipitated intracranial bleeding is unknown. Further data are needed to establish real haemorrhage risk in this clinical condition.
