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Background and importance: Intracerebral haemorrhage (ICH) is the most serious and feared complication of systemic thrombolysis for ischaemic stroke. Symptomatic ICH (sICH) usually occurs within 24–36 hours after thrombolysis (tsICH). Mainly because of the poor prognosis and the lack of clear treatment evidence, patients often are not aggressively treated, nor receive procoagulant therapy. The absence of literature on hemicraniectomy in tsICH and lack of treatment consensus is problematical to direct the care of these patients. Clinical presentation: We present a 72-year-old gentleman with an acute ischaemic stroke in the left MCA territory who had a severe intravenous thrombolysis-associated intra-cerebral haemorrhage. The patient was promptly treated with procoagulant drugs and hemicraniectomy. The clinical evolution was successful with a 12-month follow-up status with the patient presenting complete independence (modified Rankin Scale of 2). Conclusion: Despite potentially unfavourable prognosis of tsICH and the frequently nihilistic attitude to this dramatic condition, our report should be reason enough to at least consider aggressive treatment in selected cases and on an individual basis. Prospective studies addressing outcome and treatment of tsICH are needed.

Favourable outcome after aggressive treatment of a thrombolysis-associated intra-cerebral haemorrhage