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BACKGROUND: Stroke thrombolysis-related intracerebral hemorrhage may occur remotely from the anatomical site of ischemia. One postulated mechanism for this is simultaneous multiple embolization with hemorrhage into a "silent" area of ischemia. RESULTS: A patient suffered a disabling stroke affecting the right cerebral hemisphere. He was treated with intravenous alteplase and underwent extensive early imaging with multimodal MRI. Several hours after treatment he developed a brainstem hemorrhage despite having no evidence of ischemia on DWI MRI in the brainstem. CONCLUSION: Not all occurrences of remote ICH after stroke thrombolysis are secondary to multiple emboli with silent ischemia.


Journal article


BMC Neurol

Publication Date





Aged, Brain Ischemia, Diagnosis, Differential, Fatal Outcome, Fibrinolytic Agents, Humans, Intracranial Hemorrhages, Magnetic Resonance Imaging, Male, Muscle Weakness, Stroke, Tissue Plasminogen Activator, Tomography, X-Ray Computed