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Acute type A Intramural Hematoma with cerebral ischemia treated with tPA.
  • +1
  • Megan Wang,
  • Shinichiro Ikeda,
  • Benjamin Youdelman,
  • Elias Wan
Megan Wang
SUNY Downstate Medical Center

Corresponding Author:[email protected]

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Shinichiro Ikeda
Maimonides Medical Center
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Benjamin Youdelman
Maimonides Medical Center
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A 68-year-old female patient presented to the emergency department with left-sided weakness. Tissue plasminogen activator (tPA) was started for stroke, however, the patient was later found to have a type A intramural hematoma (IMH). TPA was subsequently discontinued. She was hemodynamically stable and was treated medically due to the risk of bleeding from tPA. Fortunately, the patient had a complete neurological recovery. She underwent an aortic repair 6 weeks after initial presentation and was discharged home without any complications. Aortic dissection and IMH should always be in the differential diagnosis when treating patients with signs of cerebral ischemia. This is the first documented case of accidental administration of tPA in a patient with intramural hematoma (IMH), and illustrates a successful case of delayed surgical repair for high risk IMH in patients recovering from cerebral ischemia.