Recombinant Tissue Plasminogen Activator in the Treatment of Intraventricular Hemorrhage Secondary to Periventricular Arteriovenous Malformation before Surgery: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 964-969 ◽  
Author(s):  
Krishna Kumar ◽  
Denny D. Demeria ◽  
Ashok Verma
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Malformation ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intraventricular Hemorrhage ◽  
Surgical Intervention ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Abstract OBJECTIVE AND IMPORTANCE Intraventricular hemorrhage (IVH) is known to cause acute obstructive hydrocephalus, refractory elevated intracranial pressures (ICPs), and lowered cerebral perfusion pressures, leading to cortical ischemia. Frequent obstruction of external ventricular drains as a result of thrombus is a recurring theme. We present a case of IVH secondary to periventricular arteriovenous malformation (AVM) that was not visible at admission angiography and was treated by intraventricular infusion of recombinant tissue plasminogen activator before surgical intervention. CLINICAL PRESENTATION An 11-year-old boy presented with acute onset of headache followed by two seizures, loss of consciousness, decerebration, right temporal hematoma, IVH, and acute obstructive hydrocephalus. INTERVENTION A right external ventricular drain was placed but functioned poorly. ICP could not be controlled by conventional methods. Five milligrams of recombinant tissue plasminogen activator was injected into the ventricular system via the external ventricular drain. This was repeated daily for 4 days. This treatment resulted in progressive improvement in ICP and clinical status. Once the clot partially cleared, magnetic resonance imaging and magnetic resonance angiography suggested the presence of a right periventricular arteriovenous malformation, which was confirmed by angiography and subsequently resected. CONCLUSION Recombinant tissue plasminogen activator is effective in resolving IVH causing obstructive hydrocephalus and uncontrollable ICP posing a life-threatening situation, secondary to ruptured arteriovenous malformation, before surgical intervention.

scholarly journals Using low-dose tissue plasminogen activator through external ventricular drain and Cerebrolysin for the treatment of severe intraventricular hemorrhage: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2098146
Author(s):  
Nguyen Hoang Ngoc ◽  
Nguyen Van Tuyen
Keyword(s):  
Arteriovenous Malformation ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intraventricular Hemorrhage ◽  
Low Dose ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Endovascular Embolization ◽  
Intraventricular Fibrinolysis ◽  
Tissue Plasminogen

Acute obstructive hydrocephalus is a complication of intraventricular hemorrhage, which requires a combination of medical and surgical treatments. We report a clinical case of intraventricular hemorrhage extension secondary to a ruptured arteriovenous malformation, successfully treated with a combination of methods: endovascular embolization of arteriovenous malformation, external ventricular drainage, intraventricular fibrinolysis with low-dose recombinant tissue plasminogen activator, and medical treatment with the neurotrophic drug Cerebrolysin in combination with neurorehabilitation.

scholarly journals Intraventricular Hemorrhage Secondary to Intranidal Aneurysm Rupture—Successful Management by Arteriovenous Malformation Embolization Followed by Intraventricular Tissue Plasminogen Activator

Neurosurgery ◽  
2011 ◽  
Vol 68 (2) ◽  
pp. E581-E586 ◽  
Author(s):  
Glen A. Pollock ◽  
Ali Shaibani ◽  
Issam Awad ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Arteriovenous Malformation ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drain ◽  
Aneurysm Rupture ◽  
Major Hemorrhage ◽  
Tissue Plasminogen ◽  
Elective Treatment ◽  
Rapid Clearance

Abstract BACKGROUND AND IMPORTANCE: Intraventricular hemorrhage related to arteriovenous malformation (AVM) rupture is associated with significant morbidity and mortality. Intraventricular tissue plasminogen activator (tPA) has been used to treat spontaneous intraventricular hemorrhage. We demonstrate the successful application of endovascular occlusion to seal the rupture site of an AVM followed by intraventricular tPA. CLINICAL PRESENTATION: A 32-year-old woman presented with a right frontoparietal parasagittal AVM abutting the motor cortex. The AVM was diagnosed when the patient was 13 years old, and she initially underwent conservative management. At the age of 30, the patient suffered an intracranial hemorrhage, leaving her with left hemiparesis. After rehabilitation, the patient regained ambulation; however, she remained spastic and hyperreflexic on the left side. Two years after her major hemorrhage, she presented for elective treatment of her AVM. The patient was advised to undergo staged embolization before surgical resection of her AVM. The initial embolization was uneventful. A second embolization was complicated by intraventricular hemorrhage and coma. The patient was treated with placement of an external ventricular drain followed by embolization of intranidal aneurysm. After embolization of the intranidal aneurysm the ruptured, the patient was treated with intraventricular tPA. The patient had rapid clearance of the intraventricular hemorrhage and significant improvement in her neurological examination, following commands 24 hours later and returning almost to baseline. CONCLUSION: This case demonstrates the feasibility of treating AVM-related intraventricular hemorrhage with tPA if the rupture source can be confidently sealed interventionally. This strategy can be lifesaving but needs further study to ensure its safety.

scholarly journals Magnetic Resonance Angiography of Thromboembolic Stroke in Rats: Indicator of Recanalization Probability and Tissue Survival after Recombinant Tissue Plasminogen Activator Treatment

2002 ◽  
Vol 22 (6) ◽  
pp. 652-662 ◽  
Author(s):  
Thomas Hilger ◽  
Frank Niessen ◽  
Michael Diedenhofen ◽  
Konstantin-Alexander Hossmann ◽  
Mathias Hoehn
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Thromboembolic Stroke ◽  
Vessel Occlusion ◽  
Intracranial Vessel ◽  
Mca Occlusion ◽  
Tissue Plasminogen

Magnetic resonance angiography (MRA) was performed in a thromboembolic stroke model of the rat to characterize intracranial vessel occlusion patterns and to test its predictive power for tissue recovery after recombinant tissue plasminogen activator (rt-PA) treatment. After rt-PA-treated selective middle cerebral artery (MCA) occlusion, full recanalization was observed in two of three animals, whereas additional occlusion of the circle of Willis (CW) resulted in full vascular flow restitution in only one of six rats. Tissue reperfusion markedly lagged the onset of treatment, and the delay correlated with the pattern of vessel occlusion (20 to 23 minutes for selective MCA occlusion vs. 71 to 79 minutes for combined MCA/CW occlusion). In lateral cortex and striatum the apparent diffusion coefficient decreased to 78 ± 15% of control after embolization, recovered to 80% to 85% after rt-PA treatment of selective MCA occlusion, but further declined to 66% to 69% after combined MCA/CW occlusion. Correspondingly, T2 relaxation time increased to 107% to 118% of control after selective MCA occlusion and to 112% to 124% after combined MCA/CW occlusion in these regions. The present investigation shows that MRA provides valuable information on the severity of thromboembolic stroke and has the power to predict, before the initiation of treatment, the functional tissue outcome after rt-PA-induced thrombolysis.

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