Haemorrhagic transformation of a recent silent cerebral infarct during thrombolytic stroke treatment.

We present a patient in her 60s who was admitted with a sudden loss of power in her right arm and leg, right sided facial weakness, and difficulties with speaking. An acute ischaemic stroke in the left hemisphere was diagnosed and the patient received intravenous thrombolytic treatment. Treatment was stopped halfway as a cerebral haemorrhage was suspected. A small haemorrhage in the right frontal cortex was thereafter identified on computed tomography (CT) and magnetic resonance imaging scans. Re-examination of the CT scan taken before the start of thrombolytic treatment revealed a recent silent infarct with cortical petechial haemorrhage at this site. A month later the patient still suffered from a partial paralysis in her right arm and leg, but could now walk without help; she did not have any lasting symptoms of the haemorrhage. Our case illustrates that a recent silent infarct can be a cause of a haemorrhage at an unexpected site during thrombolytic treatment.