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Remote Intracerebral Hemorrhage Following Intravenous Thrombolysis in Pregnancy at 31 Weeks Gestation: A Case Report and Review of the Literature

Jiang, Zheng MD; Hu, Zhiping MD

doi: 10.1097/NRL.0000000000000165
Case Report/Case Series

Introduction: Intravenous recombinant tissue-type plasminogen activator thrombolysis in pregnancy for acute ischemic stroke is infrequent. As a rare complication of thrombolysis, remote intracerebral hemorrhage (rICH) whose mechanisms are unclear has not gained enough attention until now.

Case Report: We present here a case of 26-year-old pregnant woman at 31 weeks gestation who suffered from sudden onset right-sided hemiparesis and slurred speech. She successfully received intravenous recombinant tissue-type plasminogen activator thrombolysis within 2.5 hours from stroke onset. Further workup demonstrated multiple and bilateral acute cerebral infarcts due to cardioembolism. At 6 hours after thrombolysis, multifocal intracerebral hemorrhages were developed in her left cerebellum and right temporal cortex, remote from the initial infarct areas. However, the patient achieved a final complete recovery of symptoms. Despite diffusion-weighted imaging could not confirm infarct in the areas of hemorrhages, multiple cerebral embolism was suggested to be involved in the etiology of rICH.

Conclusions: rICH is different from local intracerebral hemorrhage in its risk factors, neurological outcomes, and underlying mechanisms. Patients with rICH may have favorable outcomes and multiple cerebral embolism is still one of the important mechanisms for postthrombolytic rICH.

Department of Neurology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China

Supported by the National Natural Science Foundation of China (grant no. 81400994).

The authors declare no conflict of interest.

Reprints: Zheng Jiang, MD, Department of Neurology, the Second Xiangya Hospital, Central South University, 139 Mid. Renmin Rd, Changsha, Hunan 410011, China. E-mail:

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