Postthrombolysis Intracranal Hemorrhage

Post-thrombolysis intracranial hemorrhage occurs in 2% to 7% of acute stroke patients, typically within the first 12 hours of treatment. Management requires immediate cessation of thrombolytic infusion followed by a non-contrast CT scan to differentiate hemorrhage from contrast staining or stroke progression. When symptomatic hemorrhage is confirmed, treatment involves administering 10 units of cryoprecipitate to address fibrinogen depletion, alongside antifibrinolytic agents like tranexamic acid. Blood pressure should be stabilized within a target range of 130 to 150 mmHg, avoiding rapid fluctuations. Because neurological deterioration can also stem from seizure activity, metabolic imbalances, or stroke progression, clinicians must maintain a low threshold for imaging and close neurological monitoring, ideally with one-to-one nursing care during the initial 24-hour observation period. Neurointensivist Dr. Maria Muzammil emphasizes that these protocols rely on physiological rationale and expert consensus rather than robust randomized controlled trial data.