Brainstem Hyperperfusion Syndrome After Intravenous Thrombolysis: A Case Report

ABSTRACT BACKGROUND AND PURPOSE Recombinant tissue plasminogen activator (rtPA)‐associated hyperperfusion syndrome in brainstem after acute stroke has not yet been reported. The current report demonstrates that rtPA‐associated hyperperfusion syndrome can be a cause of clinical deterioration following improvement (DFI) after rtPA in acute stroke. METHODS We observed a transient DFI in a 59‐year‐old man with acute ischemic stroke who received rtPA. The phenomenon was assessed by magnetic resonance imaging (MRI) with diffusion‐weighted image (DWI) and a series of transcranial Doppler scan evaluating changes in the basilar arterial flow. RESULTS We demonstrated a reversible hyperintensity at pons on DWI as well as a transient increase in basilar arterial flow on Doppler scan suggesting the occurrence of vasogenic edema and hyperperfusion at brainstem. CONCLUSIONS rtPA‐associated hyperperfusion can occur at brainstem causing transient neurological deficits. It can be a cause of DFI in addition to reocclusion after recanalization.