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Intracerebral hemorrhage related to cerebral amyloid angiopathy and T‐PA treatment
Author(s) -
Pendlebury William W.,
Iole Elizabeth D.,
Tracy Russell P.,
Dill Ba Barbara A.
Publication year - 1991
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410290216
Subject(s) - cerebral amyloid angiopathy , medicine , intracerebral hemorrhage , autopsy , tissue plasminogen activator , cerebral infarction , subarachnoid hemorrhage , pathology , heparin , amyloid (mycology) , fibrin , angiopathy , immunology , ischemia , diabetes mellitus , endocrinology , dementia , disease
Tissue plasminogen activator (t‐PA) has been approved as thrombolytic therapy for the treatment of acute myocardial infarction, but this agent can cause serious bleeding complications including intracerebral hemorrhages. Mechanisms underlying the development of these hemorrhages have not been clarified. We report a patient who developed two intracerebral hemorrhages shortly after receiving t‐PA for the treatment of an acute myocardial infarction, and who was found to have cerebral amyloid angiopathy a autopsy. Staining of cortical sections with Congo red and an antibody directed against beta amyloid protein (A4 peptide) disclosed specific involvement of most of the subarachnoid and superficial cortical vessels in the region of the two hemorrhages. Based on the findings in this patient and in 6 additional patients reported recently, it is likely that cerebral amyloid angiopathy plays a pathogenic role in some intracerebral hemorrhages associated with the administration of t‐PA. The cautious use of t‐PA with heparin in patients who are elderly or demented may be advisable.