Intracranial Aneurysm Rupture Following Intravenous Thrombolysis for Stroke
Bibliographic record
Abstract
Treatment of acute ischemic stroke with intravenous tissue plasminogen activator (IV-tPA) has proven efficacy and safety up to 4.5 hours from clinical onset. 1 Treatment with IV-tPA may lead to potentially serious complications, the most devastating being intracranial hemorrhage (ICH).In this setting, ICH risk may be increased by advanced age, hypertension, large infarction volume, anticoagulant use, previous stroke, and cerebral vascular lesions.Current guidelines cite many of these factors, including the presence of unruptured intracranial aneurysms (UIAs), as exclusion criteria for thrombolytic therapy for acute ischemic stroke. 2 The population affected by these guidelines is not trivial: among patients with ischemic stroke, the prevalence of UIAs is between 6.6-9.3%, noticeably higher than the general population. 2 Thus, up to one in every ten patients receiving thrombolysis for acute stroke may harbor an UIA; a number that is likely to grow with advances in stroke imaging, such as computed tomogram (CT) and magnetic resonance (MR) angiography (CTA/MRA).This compounds the therapeutic dilemma created by the paucity of evidence (and subsequent controversy) regarding whether IV thrombolysis truly increases the likelihood of aneurysm rupture.Thus, "is thrombolysis in the presence of an unruptured intracranial aneurysm safe?" remains an important unanswered question, with attendant, potentially life-threatening risk, for a significant proportion of ischemic stroke patients.To date, two cases of intracranial aneurysm rupture following intravenous thrombolytic therapy have been reported: one in the setting of acute myocardial infarction, the other in a patient with symptoms of sentinel hemorrhage who received IV-tPA for ischemic stroke.3,4 We report the case of a previously asymptomatic patient with multiple UIAs who suffered massive (and ultimately fatal) subarachnoid hemorrhage (SAH) following IV-tPA for acute ischemic stroke.To our knowledge, this is the first reported case where a previously asymptomatic intracranial aneurysm was the likely cause of a massive subarachnoid hemorrhage following intravenous thrombolysis for acute ischemic stroke. CASE REPORT HistoryA 71-year-old right-handed-male presented to hospital within thirty minutes of a witnessed sudden onset right face and arm hemiparesis, right-sided neglect and global aphasia.His medical history included pneumonectomy for lung cancer, peripheral arterial disease with bilateral aortofemoral bypass, hypertension, hyperlipidemia, and 30-pack-years of smoking.The patient was not receiving antiplatelet therapy.Examination revealed blood
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".