AN AUTOPSY CASE OF INTRACRANIAL HEMORRHAGE DURING TISSUE-PLASMINOGEN ACTIVATOR INFUSION

We describe an autopsy case of severe intracranial hemorrhage which oc curred during the infusion of tissue plasminogen activator (t-PA) for acute myocardial infarction. A 75-year-old man was admitted with subst ernal chest pain of 3-h duration and elctro-cardiographic changes cons istent with an acute inferior myocardial infarction. Physical examinat ion was unremarkable, except for an initial blood pressure reading of 160/96 mmHg. The patient received 3,000 IU intravenous heparin followe d by a 2.4 x 10(6) IU bolus dose of tissue plasminogen activator (t-PA ) (Alteplase). This was followed by a drip infusion of 21.6 x 10(6) IU of t-PA over 1 h (total dose 41 mg). Thirty minutes after the infusio n of t-PA was initiated, the patient suddenly lost consciousness and b egan to have violent convulsions, followed by cardiac arrest. Autopsy revealed massive hemorrhage in the bilateral cerebrum and brain stem. To our knowledge, this is the first case of sudden death during t-PA i nfusion therapy.