INTRODUCTION: The use of plasminogen activators (PAs) in acute stroke patients has dual effects. PAs are beneficial by dissolving thrombi occluding an artery, but may be harmful by their proteolytic and excitotoxic actions. METHODS AND RESULTS: We report two patients with a fatal brain herniation who rapidly deteriorated despite the successful recanalization and the sustained arterial patency or blood flow. Imaging studies taken after the thrombolytic treatment suggested early occurrence of cellular damage and profound breakdown of the blood-brain barrier. CONCLUSION: Fatal brain edema occurred after persistent reperfusion by the thrombolytic therapy. Paradoxical thrombolytic-induced injury, which has been suggested in experimental studies, might play a role.
INTRODUCTION: The use of plasminogen activators (PAs) in acute strokepatients has dual effects. PAs are beneficial by dissolving thrombi occluding an artery, but may be harmful by their proteolytic and excitotoxic actions. METHODS AND RESULTS: We report two patients with a fatal brain herniation who rapidly deteriorated despite the successful recanalization and the sustained arterial patency or blood flow. Imaging studies taken after the thrombolytic treatment suggested early occurrence of cellular damage and profound breakdown of the blood-brain barrier. CONCLUSION: Fatal brain edema occurred after persistent reperfusion by the thrombolytic therapy. Paradoxical thrombolytic-induced injury, which has been suggested in experimental studies, might play a role.
Authors: Walther N K A van Mook; Roger J M W Rennenberg; Geert Willem Schurink; Robert Jan van Oostenbrugge; Werner H Mess; Paul A M Hofman; Peter W de Leeuw Journal: Lancet Neurol Date: 2005-12 Impact factor: 44.182
Authors: Kyung Yul Lee; Dong Ik Kim; Seo Hyun Kim; Seung Ik Lee; Hae Woong Chung; Yong Woon Shim; Seung Min Kim; Ji Hoe Heo Journal: AJNR Am J Neuroradiol Date: 2004-10 Impact factor: 3.825
Authors: Xiaoying Wang; Sun-Ryung Lee; Ken Arai; Seong-Ryong Lee; Kiyoshi Tsuji; G William Rebeck; Eng H Lo Journal: Nat Med Date: 2003-09-07 Impact factor: 53.440