Background
Thrombolysis is the most successful therapy in acute ischemic stroke. Limitations
comprise strict eligibility criteria including many contraindications for thrombolysis,
and in particular clinical situations lack of evidence-based data resulting in recommendations
based on single experiences. Therefore, the risk–benefit effect of thrombolysis in
the presence of brain tumor is unknown.
Methods
We conducted a systematic literature research of electronic databases (MEDLINE, Goggle
Scholar) covering the period from 1990 to 2012 including search terms “thrombolysis,”
“stroke,” “brain tumor,” and “intracranial neoplasm.” In addition, we report 1 new
case of a 71-year-old patient with a large right frontal meningioma who fully recovered
with thrombolysis from a severe ischemic stroke.
Results
Our literature research retrieved 12 patients with different brain tumors who were
treated with thrombolysis for different reasons. Intracerebral hemorrhage occurred
in 1 patient (8.3%) with a glioblastoma, and in the other 11 patients (91.7%), no
hemorrhage was documented. In the subgroup of 8 stroke patients, both patients with
a glioblastoma had no stroke but rather a focal seizure. Two of 3 patients with meningiomas
showed a very good benefit from thrombolysis.
Conclusions
In summary, very limited data exist about thrombolysis in patients with brain tumors.
Differentiation of tumor by additional neuroimaging before thrombolysis in ischemic
stroke is recommended as thrombolysis might be considered in extra-axial benign appearing
neoplasms (eg, meningioma) but is not advisable in intra-axial primary or metastatic
neoplasm. Further reporting of thrombolysis in patients with brain tumors is recommended.
Key Words
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Article info
Publication history
Published online: June 13, 2013
Accepted:
May 6,
2013
Received in revised form:
April 29,
2013
Received:
March 4,
2013
Footnotes
Conflicts of interest: None to declare.
Ethics: Written informed consent of the patient has been obtained.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.05.004
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
