Spontaneous Spinal Subarachnoid Hematoma after Recombinant Tissue Plasminogen Activator (rt-PA) Treatment for Acute Ischemic Stroke: A Case Report
Luckchai Phonwijit MD*, Akira Iwata MD**, Takahata Masahiko MD, PhD**
Affiliation : * Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
An 83-year old man with acute ischemic stroke was treated by intravenous recombinant tissue plasminogen activator (rt-PA). Five hours later, he developed progressive paraplegia with sensory impairment below C6 dermatome (Frankel class A). Cervical spinal MRI showed intradural extramedullary hematoma posterior to the C5 vertebral body with multiple levels of cervical stenosis and kyphotic deformity. We performed C5 corpectomy with removal of subarachnoid hematoma, C6-7 discectomy and fusion. At 6 month postoperative, the patient could walk for a short distant and still continued rehabilitation program. Spontaneous spinal subarachnoid hematoma is an extremely rare complication following rt-PA administration. Physicians must realize this condition when patients have spinal pain or progressive neurological deficit after receiving intravenous rt-PA.
Keywords : Spontaneous spinal subarachnoid hematoma, Recombinant tissue plasminogen activator, rt-PA, Progressive paraparesis
