Intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute cerebral infarction in a patient with ANCA-associated vasculitis

• Published in: Rinsho Shinkeigaku Vol. 57; no. 8; pp. 454 - 456
• Main Authors: Akutagawa, Noriko, Sadashima, Shoko, Nakagaki, Hideaki, Nagano, Sukehisa, Yoshimura, Takeo
• Format: Journal Article
• Language: Japanese
• Published: Japan Societas Neurologica Japonica 31.08.2017
• Subjects: Aged; ANCA-associated vasculitis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - complications; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis - diagnosis; Antibodies, Antineutrophil Cytoplasmic - blood; Biomarkers - blood; Cerebral Hemorrhage - etiology; cerebral infarction; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - drug therapy; Cerebral Infarction - etiology; Humans; Infusions, Intravenous; intracerebral hemorrhage; Magnetic Resonance Imaging; Male; MPO-ANCA; Recombinant Proteins - administration & dosage; Recombinant Proteins - adverse effects; rt-PA; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; intracerebral hemorrhage; MPO-ANCA; cerebral infarction; ANCA-associated vasculitis; rt-PA
• ISSN: 0009-918X; 1882-0654
• DOI: 10.5692/clinicalneurol.cn-001011

We report the case of a 68-year-old man who suddenly developed right hemiparesis. MRI of the brain revealed a new infarction in the left corona radiata, and intravenous rt-PA was administered 100 minutes after the onset of symptoms. After the rt-PA infusion was started, his consciousness declined and the CT revealed bilateral intracerebral hemorrhage. His consciousness did not improve thereafter. He was diagnosed with ANCA-associated vasculitis owing to the high levels of MPO-ANCA and urinary protein and the presence of erythrocytes without any other cause of renal damage. Although ANCA-associated vasculitis rarely involves the central nervous system, intracerebral hemorrhage as well as cerebral infarction may occur. This case provides an important opportunity to explore the implications of intravenous rt-PA therapy for acute cerebral infarction in patients with ANCA-associated vasculitis.