Document Type: Special Articles

Authors

1 Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Neurology Research Group, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Department of Neurosurgery, School of Medicine, Emdadi Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Background:  Intravenous  recombinant  tissue plasminogen  activator  (rt-PA) is an approved  treatment for acute ischemic stroke within 4.5 h of symptoms onset. Decompressive craniectomy (DC) has been  shown  as an effective  therapeutic  modality in malignant  middle cerebral  artery (MCA) infarction. As rt-PA could result in hemorrhagic  complication during or after any surgery DC may be associated with severe bleeding after intravenous thrombolysis.Case Description: A 57-year-old woman was presented 90 min after the sudden  onset of left hemiplegia. Despite intravenous  thrombolytic therapy, she lost consciousness within 48 h and brain CT scan showed a right malignant MCA infarction associated  with a small bleeding. DC was performed  without  any complication. The patient improved dramatically.Conclusion: DC could be done safety for malignant  MCA infarction after unsuccessful intravenous thrombolytic therapy  even  the later was complicated  with  intra- infarction hemorrhage.