Urokinase
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Rebleeding from an aneurysm following intrathecal injection in an elderly patient: case report A 67-year-old woman experienced rebleeding from a vertebral artery dissecting aneurysm (VADA) after receiving intrathecal urokinase. The woman was hospitalised with a subarachnoid haemorrhage (SAH); VADA was evident on angiogram, and she underwent endovascular internal tapping. Postsurgery, an angiogram showed successful complete occlusion of the right vertebral artery (VA) proximal to the aneurysm, and no retrograde flow into the aneurysm. Because of Fisher group III SAH, she received intrathecal urokinase 6000U through the lumbar drainage catheter the following morning. Three hours after the injection, she suddenly reported severe headache and subsequently became comatose. Repeat SAH was evident on CT, and angiography identified contrast medium extravasation distal to the aneurysm. Endovascular internal tapping was repeated with complete exclusion of the aneurysm from the circulation. The woman’s neurological condition gradually improved and she was transferred for rehabilitation after 2 months; at the time of discharge, severe tetraparesis persisted. Author comment: "The packing density in the aneurysm in the present case was not particularly dense but was judged to be adequate to prevent rebleeding. . . We strongly suspect that the thrombolytic effect of the urokinase might have been responsible for the rebleeding, because the arterial wall in VADA is histologically very thin." Sugiu K, et al. Rebleeding from a vertebral artery dissecting aneurysm after endovascular internal trapping: Adverse effect of intrathecal urokinase injection or incomplete occlusion? - Case report. Neurologia Medico-Chirurgica 49: 597-600, No. 12, 2009. Available from: URL: http://dx.doi.org/10.2176/nmc.49.597 803007639 Japan
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Reactions 13 Mar 2010 No. 1292
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