Intracerebral Hemorrhage after IV tPA for Stroke as Early Symptoms of ANCAAssociated Vasculitis (P6.201)

摘要: Objective: NA Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare diseases, characterized by a necrotizing small-vessel vasculitis and circulating ANCA. Both acute ischemic stroke (AIS) intracerebral hemorrhage (ICH) potential complications of these vasculitides. Intravenous tissue plasminogen activator (IV tPA) is the standard treatment for AIS not listed as contraindications its administration. However, CNS could be contraindication to IV tPA because risk ICH. We describe patient who developed multiple ICHs following administration we raise awareness dangers use in patients with AAV. Design/Methods: Results: A 58-year-old man was admitted myalgia, low grade fevers, dark urine urticarial rash right hemiparesis, dysarthria facial droop. Initial brain CT scan normal administered. Shortly afterward he deteriorated required intubation. Second showed bilateral ICHs. Further work up revealed diagnosis AAV based on high C-ANCA proteinase 3 titers. His hospital course complicated renal failure, attributed his vasculitis. Treatment started corticosteroids rituximab marked neurological improvement at month follow up. Conclusions: it usually develops delayed phase disease. But, occasion, can initial manifestation Post-mortem exams have demonstrated areas antemortem thrombi fibrinoid changes other demonstrating damaged vessels hemorrhage. believe that presence tPA, necrosis likely make more prone hemorrhagic transformation. Our case highlights ICH associated reinforces may contraindicated patients. Study Supported by: Disclosure: Dr. Zarghami has nothing disclose. Anderson Pieper Adams