Document Type : Special Articles
Authors
- Humain Baharvahdat 1
- Hamid Etemadrezaie 1
- Samira Zabyhian 1
- Zahra Valipour 2
- Babak Ganjeifar 3
- Seyed Mohammad Mousavi Mirzaye 4
- Payam Sasannejad 4
- Kavian Ghandehari 4
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.
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