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Fatal Streptokinase-Induced Intracerebral Haemorrhage in Cerebral Amyloid Angiopathy

Published online by Cambridge University Press:  18 September 2015

D.A. Ramsay ,
J.L. Penswick  and
D.M. Robertson
D.A. Ramsay
Affiliation:
Department of Pathology, Queen's University and Kingston General Hospital, Kingston
J.L. Penswick
Affiliation:
Department of Pathology, Queen's University and Kingston General Hospital, Kingston
D.M. Robertson*
Affiliation:
Department of Pathology, Queen's University and Kingston General Hospital, Kingston
*
Department of Pathology, Richardson Laboratory, Queen's University, Kingston, Ontario, Canada K7L 3N6
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Abstract:

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A fatal intracerebral haemorrhage (ICH) associated with streptokinase (SK) treatment of an acute myocardial infarction is described. Autopsy examination showed a lobar ICH and severe cerebral amyloid angiopathy (CAA). The close temporal relationship between SK administration and intracranial haemorrhage, the absence of pretreatment risk factors for ICH, and the presence of CAA suggests that these are related phenomena. Accordingly: 1. There may be a synergistic relationship between CAA and intracranial haemorrhage induced by fibrinolytic agents; 2. Thrombolytic agents may induce more frequent than expected intracranial haemorrhage in conditions associated with a high incidence of CAA, notably old age and Alzheimer's disease; 3. A regional defect in haemostasis other than vessel fragility may contribute to the intracranial haemorrhagic predisposition of CAA; 4. Autopsy examination of cases of ICH is an essential part of the audit of clinical trials of fibrinolytic agents.

Résumé:

RÉSUMÉ:

Les auteurs décrivent un cas d'hémorragie intracérébrale (HIC) fatale associée au traitement par la streptokinase (SK) d'un infarctus aigu du myocarde. À l'autopsie, on a constaté une HIC lobaire et une angiopathie amyloïde cérébrale sévère (AAC). La relation temporale étroite entre l'administration de SK et l'hémorragie intracrânienne, l'absence de facteurs de risque pour l'HIC en prétraitement et la présence d'AAC suggèrent que ces phénomènes sont reliés. Par conséquent: 1. Il peut y avoir une relation synergique entre l'AAC et l'hémorragie intracrânienne induite par les agents fibrinolytiques; 2. Les agents thrombolytiques peuvent induire plus fréquemment que prévu une hémorragie intracrânienne dans les affections associées à une incidence élevée d'AAC, particulièrement chez les vieillards et les patients atteints de la maladie d'Alzheimer; 3. Un défaut régional de l'hémostase autre que la fragilité vasculaire peut contribuer à la prédisposition à l'hémorragie intracrânienne de l'AAC; 4. L'autopsie des cas d'HIC est un élément essentiel de la révision des essais cliniques avec des agents fibrinolytiques.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 3 , August 1990 , pp. 336 - 341
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

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