• Chi-Ieong Lau, Li-Ming Lien, and Wei-Hung Chen.
• Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
• J Neuroimaging. 2011 Jul 1; 21 (3): 277-9.

Background And PurposeRecombinant 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.MethodsWe 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.ResultsWe 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.ConclusionsrtPA-associated hyperperfusion can occur at brainstem causing transient neurological deficits. It can be a cause of DFI in addition to reocclusion after recanalization.© 2010 by the American Society of Neuroimaging.

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