Bleeding is a feared adverse effect of intravenous thrombolysis. Despite the widespread use of intravenous recombinant tissue-type plasminogen activator (rtPA) in stroke, there are few significant extracranial bleedings [1-3]. We report a case of neck hema-toma after intravenous rtPA for stroke, which to our best knowledge has not been previously described.A 49-year-old man with a history of alcohol abuse as well as cigarette and cannabis smoking was admitted due to the sudden onset of left body weakness while standing. There was no history or sign of trauma. Neurological examination disclosed hemi-in-attention, left gaze palsy, left homonymous hemianopia, dysar-thria, left facial paresis, hemisensory loss and hemiparesis (NI-HSS score 14). A brain computerized tomography (CT) scan was unremarkable. Platelet count, activated partial thromboplastin time and prothrombin time were normal. Intravenous rtPA administration was started 2.5 h after symptom onset with a total alteplase dose of 68 mg (0.9 mg/kg). Fifty minutes after perfusion start, hemi-inattention and limb weakness increased (NIHSS score 17). At the end of rtPA perfusion, a right cervical hematoma was noticed (fig. la). Cervical CT performed 1 h afterwards showed a hematoma surrounding the right internal carotid artery (ICA) extending to the subcutaneous neck tissue and a diminished caliber of the right ICA lumen (fig. lb, c).
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