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DOI: 10.1055/s-0041-1733920
Stroke Mimics – Glioblastoma Presenting with Hemorrhage after Thrombolysis: Case Report
Stroke mimics – Glioblastoma apresentando hemorragia após trombólise: Relato de caso
Abstract
Background Stroke is a clinical syndrome characterized by a sudden-onset neurological deficit of vascular cause. Stroke-like clinical symptoms that are later found to have nonvascular disorders have been termed stroke mimics (MIM), and their incidence ranges from 1.3 to 25% in patients not treated with thrombolytic therapy. Eventually, intravenous thrombolysis of MIM may occur.
Case Description We describe a 74-year-old woman with abrupt global aphasia who received thrombolytic therapy after the presumed diagnosis of acute ischemic stroke. She gradually improved despite the finding of an asymptomatic left temporal hematoma on the computed tomography (CT) scan. Two months later, she presented with a new focal neurological deficit and was diagnosed with a glioblastoma in the topography of the previous bleeding.
Conclusion This case highlights the rare occurrence of hemorrhage after thrombolysis in patients with MIM.
Resumo
Introdução O acidente vascular encefálico (AVC) é uma síndrome clínica caracterizada por déficit neurológico de início súbito. Casos nos quais a sintomatologia é semelhante aos AVCs e que, posteriormente, são identificados como distúrbios não vasculares, foram denominados de stroke mimics, cuja incidência varia entre 1,3 e 25% em pacientes diagnosticados com AVC. Eventualmente, pode ocorrer trombólise intravenosa de stroke mimics.
Descrição do caso Descrevemos o caso de uma mulher de 74 anos com afasia global abrupta que recebeu terapia trombolítica após o diagnóstico presumido de AVC isquêmico. A paciente apresentou melhora gradual dos sintomas apesar do achado na tomografia computadorizada (TC) de crânio de um hematoma temporal esquerdo assintomático. Dois meses depois, a paciente apresentou novo déficit neurológico focal e foi diagnosticada com glioblastoma na topografia do sangramento anterior.
Conclusão Este caso destaca a rara ocorrência de hemorragia após trombólise em paciente portador de glioblastoma e com diagnóstico inicial de AVC isquêmico.
Publikationsverlauf
Eingereicht: 14. November 2020
Angenommen: 16. Juni 2021
Artikel online veröffentlicht:
13. Juni 2022
© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Nguyen PL, Chang JJ. STROKE MIMICS AND ACUTE STROKE EVALUATION: CLINICAL DIFFERENTIATION AND COMPLICATIONS AFTER INTRAVENOUS TISSUE PLASMINOGEN ACTIVATOR. J Emerg Med 2015; 49 (02) 244-252 DOI: 10.1016/j.jemermed.2014.12.072.
- 2 Klüenemann HH, Skljarevski V, Hamill RW. A stroke-like presentation of glioblastoma multiforme. J Stroke Cerebrovasc Dis 2003; 12 (01) 47-48 DOI: 10.1053/jscd.2003.8.
- 3 Zinkstok SM, Engelter ST, Gensicke H. et al. Safety of thrombolysis in stroke mimics: results from a multicenter cohort study. Stroke 2013; 44 (04) 1080-1084 DOI: 10.1161/STROKEAHA.111.000126.
- 4 Grimm SA, DeAngelis LM. Intratumoral hemorrhage after thrombolysis in a patient with glioblastoma multiforme. Neurology 2007; 69 (09) 936-936 DOI: 10.1212/01.wnl.0000265392.03231.ac.
- 5 Chen H, Cebula H, Schott R, Dietemann JL, Froelich S. Glioblastoma multiforme presenting with ischemic stroke: case report and review of the literature. J Neuroradiol 2011; 38 (05) 304-307 DOI: 10.1016/j.neurad.2011.01.008.