2813 Subhyaloid haemorrhage post thrombolysis: an under recognised complication?

• Published in: BMJ neurology open 2023-08, Vol.5 (Suppl 1), p.A56-A57
• Main Authors: Kline, Katharine, Gopinath, Sumana
• Format: Article
• Language: English
• Subjects: Aphasia; Hemorrhage; Poster Abstract
• ISSN: 2632-6140
• DOI: 10.1136/bmjno-2023-ANZAN.157

IntroductionImpairment of vision following an acute stroke is a common finding with many aetiologies in this population. Acute changes in vison post thrombolysis although also frequently observed is often overlooked. This case demonstrates an important complication post thrombolysis, subhyaloid and vitreous haemorrhage, which can benefit from early recognition and management.CaseAn 80 year old female presented as a stroke code, within thrombolysis window, with expressive and receptive aphasia, right sided weakness, NIHSS 8. Initial stroke series imaging with CT brain, CT carotid angiogram and CT perfusion scan did not identify an established stroke, large vessel occlusion or definitive perfusion defect. The patient was thrombolysed with Alteplase 0.9mg/kg, and transferred to the intensive care unit, as per local protocol for ongoing observation. There was rapid improvement in her right sided weakness with more gradual improvement in her aphasia. Day 1 post thrombolysis a non contrast CT brain was performed and was reported negative for haemorrhage. The patient reported altered vision in her left eye, worsening over the 24 hours since thombolysis. A further non contrast CT brain demonstrated an acute posterior haemorrhage within the left globe that had been present but not noted on previous imaging. Formal ophthalmology review and B scan ultrasonography confirmed subhyaloid haemorrhage with further vitreous haemorrhage. The patient proceeded to undergo vitrectomy under sedation with mild improvement in visual acuity at 3 months post discharge.