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 intracere bral hemorrhage remains a risk from such therapy. Few data exist defining p atients at risk for this outcome. We report clinical and neuropathological data on a patient fulfilling NINDS rt-PA study and ECASS-2 inclusion criter ia with an acute stroke due to high-grade carotid artery stenosis and prece ded by amaurosis fugax. He died from an intracerebral hemorrhage after syst emic fibrinolysis. The fatal outcome adds support to recommendations that r apid Doppler-sonographic evaluation of the extra- and intracranial vascular status be undertaken before systemic rt-PA is implemented in acute ischemi c stroke.