Cerebral aneurysm rupture after r-TPA thrombolysis for acute myocardial infarction

BACKGROUND Intracranial hemorrhage is the most dreaded risk of thrombolytic therapy fo r acute myocardial infarction because of the high mortality and disability rates associated with this complication. Brain structural lesions may predi spose a patient to bleeding. To date, aneurysm rupture has not been describ ed as a complication of such therapy. CASE DESCRIPTION A 66-year-old hypertensive woman was admitted because of chest pain. Myocar dial infarction was diagnosed and fibrinolytic therapy with recombinant tis sue plasminogen activator (r-TPA) was initiated. Eight hours after admissio n she became unconscious. Brain computed tomography scan showed subarachnoi d hemorrhage, and a cerebral arteriography showed an anterior communicating artery aneurysm. Because of her poor clinical Condition treatment was post poned. Death occurred 7 days later because of multiorgan failure. CONCLUSIONS Cerebral aneurysms should be considered as a possible contributing factor t o intracranial bleeding after thrombolytic therapy. (C) 1999 by Elsevier Sc ience Inc.