Intracranial Hemorrhage versus Contrast Extravasation Following Thrombolytic Therapy

We report the case of a 51-year-old female with history of end stage renal disease on hemodialysis who presented with right hemiplegia and aphasia. On admission, head CT was negative for intracranial hemorrhage. MRI showed an area of acute infarct in the left parietal lobe. The patient received intravenous tissue plasminogen activator. Head CT 24 hours later showed areas of increased density in the left parietal and posterior temporal lobes. Contrast extravasation with superimposed intracranial hemorrhage could not be excluded. Therefore, antiplatelet therapy was held. A follow up CT scan demonstrated the same findings. Another head CT was obtained after hemodialysis showed resolution of the previously noted areas of increased density suggesting that contrast extravasation was the reason of increased density areas.