• Tatsuya Ueno, Takashi Nakamura, Hiroki Hikichi, Akira Arai, Chieko Suzuki, and Masahiko Tomiyama.
• Department of Neurology, Aomori Prefectural Central Hospital, Aomori, Japan. Electronic address: tatsuya_ueno@med.pref.aomori.jp.
• J Stroke Cerebrovasc Dis. 2018 Dec 1; 27 (12): e237-e238.

AbstractA 76-year-old Japanese man was admitted to our department because of aphasia and right hemiparesis. Brain magnetic resonance imaging showed cerebral infarction caused by occlusion of the left middle cerebral artery, and alteplase therapy was started. Thrombectomy was subsequently performed, resulting in recanalization. On day 4 after admission, he complained of epigastric pain when coughing. On day 8, contrast-enhanced computed tomography showed a left abdominal rectus sheath hematoma without extravasation. We carefully followed up the patient with conservative therapy, and the rectus sheath hematoma was ameliorated. Rectus sheath hematomas present as acute abdominal pain and are often misdiagnosed. Although several predisposing factors for rectus sheath hematomas have been identified, whether recombinant tissue-type plasminogen activator causes rectus sheath hematomas, remains unclear. This case highlights the need to consider a rectus sheath hematoma as a differential diagnosis of abdominal pain following treatment with recombinant tissue-type plasminogen activator.Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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