A 58-year-old woman is brought to the emergency department for shortness of breath and chest pain. Pulmonary angiography shows a large saddle embolus in the pulmonary arteries. Emergency drug therapy is administered and she is admitted to the hospital for observation. A follow-up CT scan of the chest shortly after admission shows that the thrombus has disappeared. Five hours later, the patient is found to be lethargic with slurred speech. Physical examination shows decreased consciousness, dysarthria, and optic disc swelling bilaterally. Which of the following is the most likely cause of her neurological symptoms?

Question

Quizplus · Accepted Answer

Eductional Objective: Intracerebral hemorrhage is a severe but rare complication of thrombolytic therapy (e.g., alteplase, streptokinase), which this patient most likely received for her acute saddle pulmonary embolism. Thrombolytics increase the conversion of plasminogen to plasmin and also result in increases in PT and PTT. In this case, the thrombolytic adequately dissolved the thrombus but also led to hemorrhagic stroke and increased intracranial pressure, as evidenced by her change in mental status and papilledema.

A 58-Year-Old Woman Is Brought to the Emergency Department for Shortness