Yeo Leonard L L, Lim Joline Si Jing, Sharma Vijay K
Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore.
J Neurol Sci. 2009 Sep 15;284(1-2):190-1. doi: 10.1016/j.jns.2009.04.016. Epub 2009 May 2.
Intracranial bleeding is an important and dangerous complication associated with thrombolytic therapy for acute ischemic stroke. Spinal hemorrhage has been reported after systemic thrombolysis for various conditions other than acute ischemic stroke. Our patient presented with an acute ischemic stroke and showed significant clinical recovery during intravenous thrombolysis. CT scan of the brain, performed about 6 h later due to neurological deterioration did not reveal any bleeding or a new infarction. However, an acute epidural hematoma was noted on MRI of the cervical spine. She was treated conservatively and showed a satisfactory recovery. We report, probably the first case of spinal epidural hemorrhage after systemic thrombolysis for acute ischemic stroke. Spinal hemorrhage should be considered as a differential diagnosis for neurological worsening after intravenous thrombolysis for acute ischemic stroke, especially when the brain imaging studies do not reveal an appropriate intracranial pathology.
颅内出血是急性缺血性卒中溶栓治疗相关的一种重要且危险的并发症。除急性缺血性卒中外，全身溶栓治疗其他各种疾病后也曾有脊髓出血的报道。我们的患者表现为急性缺血性卒中，在静脉溶栓期间临床症状有显著改善。约6小时后，因神经功能恶化进行了脑部CT扫描，未发现任何出血或新的梗死灶。然而，颈椎MRI检查发现了急性硬膜外血肿。她接受了保守治疗，恢复情况良好。我们报道了可能是首例急性缺血性卒中全身溶栓后发生脊髓硬膜外出血的病例。对于急性缺血性卒中静脉溶栓后神经功能恶化的情况，应考虑脊髓出血作为鉴别诊断，尤其是当脑部影像学检查未发现合适的颅内病变时。
