Matsuzono Kosuke, Nagaoka Lisa, Suzuki Masayuki, Kim Younhee, Ozawa Tadashi, Mashiko Takafumi, Shimazaki Haruo, Koide Reiji, Fujimoto Shigeru
Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
Division of Neurology, Department of Internal Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan.
J Stroke Cerebrovasc Dis. 2019 Apr;28(4):e24-e26. doi: 10.1016/j.jstrokecerebrovasdis.2018.12.045. Epub 2019 Jan 14.
Fatalities following intravenous recombinant tissue-type plasminogen activator therapy have been reported. Major fatal complications following intravenous recombinant tissue-type plasminogen activator therapy include intracranial hemorrhage, aortic dissection, and extracranial bleeding. However, the possibility that intravenous recombinant tissue-type plasminogen activator therapy itself paradoxically induces synchronized multiple cerebral novel infarctions has never been considered. We herein report the first case of bilateral internal carotid artery infarction with onset seizure following intravenous recombinant tissue-type plasminogen activator therapy for a vertebral-basilar artery infarction. A 75-year-old man was transferred to our hospital and diagnosed with acute ischemic stroke in the basilar artery. His National Institute of Health Stroke Scale score was 4. The intravenous recombinant tissue-type plasminogen activator therapy was initiated 234 minutes after stroke onset because no contraindications were present. Almost 2 hours after the intravenous recombinant tissue-type plasminogen activator therapy, the patient suddenly fell into a deep coma with generalized convulsions. A huge secondary infarction was found in the bilateral anterior circulation territories, and he died 7 days after stroke onset. This case alerts clinicians to the possibility of synchronized multiple cerebral infarctions following intravenous recombinant tissue-type plasminogen activator therapy as a dangerous complication in patients with multiple severe stenoses in the cerebral arteries.
静脉注射重组组织型纤溶酶原激活剂治疗后出现死亡病例已有报道。静脉注射重组组织型纤溶酶原激活剂治疗后的主要致命并发症包括颅内出血、主动脉夹层和颅外出血。然而，静脉注射重组组织型纤溶酶原激活剂治疗本身反常地诱发同步多发性脑新梗死的可能性从未被考虑过。我们在此报告首例在静脉注射重组组织型纤溶酶原激活剂治疗椎基底动脉梗死时出现发作性癫痫的双侧颈内动脉梗死病例。一名75岁男性被转诊至我院，诊断为基底动脉急性缺血性卒中。他的美国国立卫生研究院卒中量表评分为4分。由于不存在禁忌证，在卒中发作234分钟后开始静脉注射重组组织型纤溶酶原激活剂治疗。静脉注射重组组织型纤溶酶原激活剂治疗后近2小时，患者突然陷入深度昏迷并伴有全身性惊厥。在双侧前循环区域发现巨大的继发性梗死，患者在卒中发作7天后死亡。该病例提醒临床医生，对于脑动脉存在多处严重狭窄的患者，静脉注射重组组织型纤溶酶原激活剂治疗后可能出现同步多发性脑梗死这一危险并发症。
