Subarachnoid hemorrhage-a rare complication after intravenous thrombolysis in an ischemic stroke patient

Arterial dissection is an uncommon cause of ischemic stroke and a big challenge to diagnose before initiation of thrombolytic therapy within such a narrow therapeutic window. We present a 47-year-old woman who encountered a rare but lethal complication-subarachnoid hemorrhage-after intravenous thrombolytic therapy within an adequate time window. The stroke mechanism may have been spontaneous dissection of the intracranial internal carotid artery extending to the middle cerebral artery. We review the literature and believe that this is the first patient complicated with a subarachnoid hemorrhage after intravenous tissue plasminogen activator. How to prevent this complication is also discussed.