Fatal Streptokinase-Induced Intracerebral Haemorrhage in Cerebral Amyloid Angiopathy

• Published in: Canadian journal of neurological sciences 1990-08, Vol.17 (3), p.336-341
• Main Authors: Ramsay, D.A., Penswick, J.L., Robertson, D.M.
• Format: Article
• Language: English
• Subjects: Amyloidosis - physiopathology; Biological and medical sciences; Brain - diagnostic imaging; Brain - pathology; Cerebral Hemorrhage - chemically induced; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - pathology; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - pathology; Drug toxicity and drugs side effects treatment; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Original Articles; Pharmacology. Drug treatments; Risk Factors; Streptokinase - adverse effects; Streptokinase - therapeutic use; Tomography, X-Ray Computed; Toxicity: nervous system and muscle
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/S0317167100030705

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.