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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
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Simultaneous Intracranial and Spinal Hemorrhage Following Tenecteplase Thrombolysis for ST-Elevation Myocardial
Thamalee Palliyaguru1, Pramith Ruwanpathirana1, Praveen Weeratunga1,2
1Professorial Unit in Medicine National Hospital of Sri Lanka Colombo Sri Lanka.
Clinical Case Reports
|February 2, 2026
Summary
Tenecteplase, a thrombolytic drug, can cause simultaneous brain and spinal hemorrhages, even without pre-existing conditions. Clinicians must monitor for these central nervous system (CNS) bleeding risks.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Central nervous system (CNS) hemorrhage is a known complication of intravenous thrombolysis.
- Tenecteplase is a fibrin-specific thrombolytic agent with a reported lower risk of hemorrhage compared to other agents.
Purpose of the Study:
- To report the first documented case of simultaneous intracranial and spinal hemorrhage following intravenous tenecteplase administration.
- To highlight the potential for concurrent CNS hemorrhages with tenecteplase, even in the absence of predisposing factors.
Main Methods:
- Case report of a 55-year-old woman with ST-elevation myocardial infarction treated with tenecteplase.
- Diagnostic workup included CT angiogram, MRI spine, and non-contrast CT brain.
- Monitoring for neurological deficits and complications.
Main Results:
- The patient developed acute paraparesis and was diagnosed with spinal epidural hemorrhage and compressive myelopathy.
- A concurrent intracranial hemorrhage in the left frontal lobe was identified.
- No pre-existing arteriovenous malformations, cavernoma, or coagulopathy were found.
Conclusions:
- Tenecteplase can lead to simultaneous intracranial and spinal hemorrhages.
- Vigilance for both cranial and spinal hemorrhagic complications is crucial, even when using fibrin-specific agents like tenecteplase.
- This case underscores the importance of considering CNS bleeding risks associated with thrombolytic therapy.
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