# Stroke Thrombolysis in the Context of a Pituitary Macroadenoma

## TL;DR

A patient with a brain tumor received stroke treatment and recovered well, suggesting guidelines may need reevaluation.

## Contribution

Presents a case where stroke thrombolysis was safely administered to a patient with an intracranial tumor.

## Key findings

- The patient showed excellent functional recovery after thrombolysis without intracranial hemorrhage.
- Current evidence on excluding tumor patients from stroke treatment is limited and of low quality.
- Published case reports provide inconsistent conclusions about the risks involved.

## Abstract

The presence of an intracranial tumour is a relative or absolute contraindication to stroke thrombolysis by most guidelines across the world. This is based on the risk of iatrogenic symptomatic intracranial haemorrhage related to the tumour. We present a patient where the decision to proceed with thrombolysis was complicated by an incidental finding of an intracranial tumour. The decision was made to proceed with thrombolysis. The patient had excellent functional recovery in the hours after administration and didn’t suffer any intracranial haemorrhage. The evidence around excluding this patient group from thrombolysis is scant and mostly of low quality. Original randomised controlled trials or stroke thrombolysis excluded this patient group and there have been none since. Published case reports and series are heterogeneous in their conclusions regarding the risk of symptomatic haemorrhage following thrombolysis in patients with intra-axial and extra-axial neoplasms. Further studies may clarify guidelines.