decompressive craniectomy after unsuccessful intravenous thrombolysis of malignant cerebral infarction.

background:  intravenous  recombinant  tissue plasminogen  activator  (rt-pa) is an approved  treatment for acute ischemic stroke within 4.5 h of symptoms onset. decompressive craniectomy (dc) has been  shown  as an effective  therapeutic  modality in malignant  middle cerebral  artery (mca) infarction. as rt-pa could result in hemorrhagic  complication during or after any surgery dc may be associated with severe bleeding after intravenous thrombolysis. case description: a 57-year-old woman was presented 90 min after the sudden  onset of left hemiplegia. despite intravenous  thrombolytic therapy, she lost consciousness within 48 h and brain ct scan showed a right malignant mca infarction associated  with a small bleeding. dc was performed  without  any complication. the patient improved dramatically. conclusion: dc could be done safety for malignant  mca infarction after unsuccessful intravenous thrombolytic therapy  even  the later was complicated  with  intra- infarction hemorrhage.