Secondary Stroke After Thrombolytic Administration; A Case Report

Ischemic stroke is still a leading cause of death and long-term disability all around the world. Restoration of blood flow with thrombolytic agents like tissue plasminogen activator (t-PA) is the only way that may rescue patients exposed to cerebral ischemia. Complications of these agents are commonly related to hemorrhage, arterial reocclusion, anaphylaxis, or reperfusion damage. Recurrence of stroke in the same or other cerebral arteries only rarely causes early deterioration during or shortly after thrombolytic administration. We report a patient who experienced a second stroke despite intravenous thrombolytic therapy. A 68-year-old man with the history of uncontrolled hypertension and diabetes mellitus presented with acute ischemic stroke in the territory of vertebrobasilar system to the emergency department. Atrial fibrillation (AF) rhythm, high blood sugar and uncontrolled hypertension were recorded on admission. Echocardiography performed before thrombolysis, did not identify any embolic sources. Five Hours after intravenous injection of tissue Plasminogen Activator (t-PA), the patient became comatose and developed a recurrent infarction in the territory of right middle cerebral artery (MCA). It seems that thrombolysis therapy in patients with the risk factors of recurrent stroke, must be done with more preparation and readiness for concurrent processing. Regardless of normal trans-thoracic echocardiography, in patients with AF rhythm, transesophageal echocardiography may be helpful. Also performing appropriate randomized trial to compare the incidence of recurrent stroke in patients under t-PA therapy and controls were still needed.