Cerebral infarction following thrombolysis for massive pulmonary embolism

A 29-year-old mate developed a fatal stroke 6 h after successful thrombolysis for massive pulmonary embolism. Autopsy showed thrombus protruding through a patent foramen ovate (PFO). A strand of thrombus extended from the aortic arch into the Left common carotid artery. The brain showed extensive infarction of the left fronto-parietat area. Thrombolysis caused initial disintegration of the embolism. It is likely that thrombolysis caused fragments of clot to Later break lose and embotise into the cerebral circulation. We discuss the need for risk stratification in patients who present with massive pulmonary embolism and PFO. (c) 2005 Elsevier Ireland Ltd. All rights reserved.