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Updated: Feb 26, 2026

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Thrombolysis-related Multiple Lobar Hemorrhaging in Cerebral Amyloid Angiopathy with Extensive Strictly Lobar

Makoto Eriguchi1, Yusuke Yakushiji1, Jun Tanaka1

  • 1Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Japan.

Internal Medicine (Tokyo, Japan)
|July 19, 2017
PubMed

Insights

Thrombolysis for ischemic stroke in an 86-year-old man with cerebral amyloid angiopathy (CAA) led to asymptomatic hemorrhaging. Patients with CAA may face increased risk of brain bleeds after thrombolysis.

Area of Science:

  • Neurology
  • Neuroradiology

Background:

  • Ischemic stroke treatment involves thrombolysis, but safety concerns exist in patients with cerebral amyloid angiopathy (CAA).
  • Cerebral amyloid angiopathy (CAA) is associated with cerebral microbleeding (CMB) and an increased risk of intracerebral hemorrhage (ICH).

Observation:

  • An 86-year-old male with hemi-paralysis and ischemic stroke underwent thrombolysis.
  • Pre-thrombolysis MRI showed extensive lobar cerebral microbleeding (CMB).
  • Post-thrombolysis CT revealed asymptomatic multiple intracerebral hemorrhages (ICH).

Findings:

  • The patient's age, CMB pattern, and low CSF amyloid-beta levels supported a CAA diagnosis.
  • Thrombolysis in this CAA patient resulted in ICH, although asymptomatic.

Implications:

  • The case highlights the potential risk of thrombolysis-induced ICH in patients with CAA.
  • Further research is needed to establish consensus on the safety of thrombolysis for acute stroke in CAA patients.
  • CAA patients might experience a higher incidence of thrombolysis-related ICH compared to non-CAA patients.
Keywords:
cerebral amyloid angiopathycerebral infarctioncerebral microbleedingintracerebral hemorrhagingthrombolysis

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