Intracranial Hemorrhage versus Contrast Extravasation Following Thrombolytic Therapy

Area of Science:

• Neurology
• Nephrology
• Radiology

Background:

• End-stage renal disease (ESRD) patients on hemodialysis have increased stroke risk.
• Acute ischemic stroke requires prompt diagnosis and treatment.

Observation:

• A 51-year-old female with ESRD on hemodialysis presented with right hemiplegia and aphasia.
• Initial CT was negative for hemorrhage; MRI revealed acute left parietal infarct.
• Treatment with intravenous tissue plasminogen activator was initiated.

Findings:

• Post-treatment CT showed increased density in the left parietal and temporal lobes, initially concerning for hemorrhage.
• Contrast extravasation was suspected as the cause of increased density.
• Resolution of increased density after hemodialysis supported contrast extravasation as the cause.

Implications:

• This case highlights the diagnostic challenges in ESRD patients undergoing stroke treatment.
• Careful interpretation of imaging, considering potential contrast extravasation, is crucial.
• Hemodialysis may aid in resolving contrast-related imaging abnormalities.