STROKE-tPA COMPLICATIONS

SUMMARY

1. Hemorrhage: 5-10% risk. Hemorrhagic transformation is almost universal in large infarcts, however this can be inconsequential.

2. Large ICH with cerebral oedema: what we don't want is ICH large enough to cause mass effect! Imaging risk factors: CT hypodensity, severe leukoaraiosis, large core & severe hypoperfusion, delayed reperfusion.

3. Risk of mortality in patients with post-thrombolysis hemorrhage: < 1%

4. Thrombolysis requires access to good neurosurgery, stroke physician and clot-retrieval service: in the event of life-threatening haemorrhage.

5. Orolingual angioedema: unilateral swelling around lips and tongue, contralateral to the brain lesion. Prevalence: ~2% overall, 5% if taking ACEI. Manage with hydrocortisone, usually doesn't require intubation.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].