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Symptomatic hemorrhage after alteplase therapy not due to silent ischemia

Published by National Institutes of Health | U.S. Department of Health & Human Services | Catalog Last Checked: September 07, 2025 at 09:55 AM | Dataset Last Updated: September 06, 2025
Background Stroke thrombolysis-related intracerebral hemorrhage may occur remotely from the anatomical site of ischemia. One postulated mechanism for this is simultaneous multiple embolization with hemorrhage into a "silent" area of ischemia. Results A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem. Conclusion Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.

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