J Clin Neurol.  2008 Mar;4(1):29-32. 10.3988/jcn.2008.4.1.29.

Life-Threatening Anaphylactoid Reaction in an Acute Ischemic Stroke Patient With Intravenous rt-PA Thrombolysis, Followed by Successful Intra-Arterial Thrombolysis

Affiliations
  • 1Department of Neurology, The Catholic University of Korea, Kang-nam St. Mary's Hospital, Seoul, Korea. nuyikim@catholic.ac.kr
  • 2Department of Neurology, The Catholic University of Korea, St. Mary's Hospital, Seoul, Korea.

Abstract

An anaphylactoid reaction to recombinant tissue plasminogen activator (rt-PA) is an uncommon but fatal complication. A 39-year-old man was admitted within 1 hour of the onset of a right hemispheric stroke. He was not taking any specific medication, including angiotensin-converting enzyme (ACE) inhibitors. A systemic anaphylactoid reaction developed immediately after rt-PA infusion. However, the symptoms were improved after treatment with a steroid and antihistamine. Subsequent intra-arterial thrombolytic therapy resulted in complete recanalization and clinical improvement. To our knowledge, this is the first report of a life-threatening anaphylactoid reaction after rt-PA treatment followed by successful intra-arterial thrombolytic therapy in a patient who had not taken an ACE inhibitor.

Keyword

Recombinant tissue plasminogen activator; Acute ischemic stroke; Anaphylactoid reaction

MeSH Terms

Adult
Humans
Stroke
Thrombolytic Therapy
Tissue Plasminogen Activator
Tissue Plasminogen Activator

Figure

  • Figure Sulcal effacement of the right middle cerebral artery (MCA) territory evident on pretreatment CT scans (A, B). Infusing 80,000 U of urokinase into the occluded right MCA (C) resulted in complete recanalization being evident on the final angiogram (D).


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