Introduction: Cerebral Micro-Bleeds (CMBs) increase the risk of haemorrhagic transformation following IV thrombolysis and controversy exists over whether they are a contraindication for thrombolysis. Methods: An 81 year old female presented with a 5-hour history of left hemiplegia (NIHSS 5). CT/CTA showed a right occipital infarct and bilateral vertebral arteries stenosis with no large vessel occlusion (LVO). Her ECG showed rate-controlled Atrial Fibrillation. She was admitted, given Aspirin 300mg and managed in the Hyper-Acute Stroke Unit. MRI Brain day 3 showed acute infarction of the right temporo-occipital region and thalamus, Gradient Echo sequence (GRE) showed multiple CMBs throughout the parenchyma including a small lesion in the pons. She developed new onset left hemiparesis on day 9 of admission. NIHSS was 12 and CT/CTA showed the established infarct and no LVO. The decision was made to administer lose-dose IV rTPA 0.6 mg/kg given her recent infarct, antiplatelet therapy and CMBs on MRI. Repeat NIHSS was 6 at 24 hours and MRI Brain was performed. Results: Repeat MRI showed interval increase in extent of the known acute right temporo-occipital infarct and blooming of a previous micro-bleed in the left paracentral pons on GRE as shown in the images presented. Conclusion: Low-dose rTPA can cause enlargement of CMBs. Age of CMBs cannot be determined accurately on MRI.
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