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Symptomatic hemorrhage after alteplase therapy not due to silent ischemia
Journal article published in 2001 by
Michael D. Hill,
Pa A. Barber,
Am M. Demchuk,
Rj J. Sevick,
Richard Frayne,
Am M. Buchan 
Abstract
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.