Cerebral hemorrhage after systemic fibrinolysis in a patient with severe carotid artery stenosis.

Despite the beneficial effect of systemic fibrinolysis in treatment within 3 hours from ischemic stroke onset, the unpredicted occurrence of intracerebral hemorrhage remains a risk from such therapy. Few data exist defining patients at risk for this outcome. We report clinical and neuropathological data on a patient fulfilling NINDS rt-PA study and ECASS-2 inclusion criteria with an acute stroke due to high-grade carotid artery stenosis and preceded by amaurosis fugax. He died from an intracerebral hemorrhage after systemic fibrinolysis. The fatal outcome adds support to recommendations that rapid Doppler-sonographic evaluation of the extra- and intracranial vascular status be undertaken before systemic rt-PA is implemented in acute ischemic stroke.