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Images in Neurology
April 2013

Successful Repetitive Intravenous Thrombolysis in a Patient With Recurrent Brainstem Infarctions Due to Megadolichobasilar Ectasia

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Cambron, Van Hooff, De Keyser, and Brouns) and Radiology (Dr Nieboer), Universitair Ziekenhuis Brussel, and Center for Neurosciences (C4N), Vrije Universiteit Brussel (Drs Cambron, Van Hooff, De Keyser, and Brouns), Brussels, Belgium; and Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands (Dr De Keyser).

JAMA Neurol. 2013;70(4):520-521. doi:10.1001/jamaneurol.2013.618

Megadolichobasilar ectasia is defined as marked elongation, widening, and tortuosity of the basilar artery.1 Intracranial dolichoectasia is associated with an increased risk of ischemic and hemorrhagic stroke and is found in 10% to 12% of patients with stroke.2 Intravenous (IV) administration of recombinant tissue plasminogen activator (rtPA) is the only approved therapy for acute ischemic stroke3 but is contraindicated in patients with increased risk of intracranial hemorrhage. Data on the bleeding risk in patients with megadolichobasilar ectasia treated with IV rtPA are nonexistent.

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