Skip to main content
Log in

Severe acute myocardial infarction during a staphylococcal septicemia with meningoencephalitis

A possible contraindication to thrombolytic treatment

  • Case Reports
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

We report the first case of lethal intracranial haemorrhage complicating a treatment by rt-PA in a patient presenting with a simultaneous staphylococcal septicemia with meningoencephalitis and an acute myocardial infarction with cardiogenic shock. The presence of microvascular lesions in the central nervous system seems to be important risk factor for intracranial haemorrhage and we recommend extreme caution in the use of thrombolytic treatment in septicemic patients with acute myocardial infarction, particularly when neurological symptoms are present.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Komrad MS, Coffey CE, Coffey KS, McKinnis R, Massey EW, Califf RM (1984) Myocardial infarction and stroke. Neurology 34:1403–1409

    Google Scholar 

  2. Wilcox RG, Olsson CG, Skene AM, Von Der Lippe G, Jensen G, Hampton JR for the ASSET Study Group (1988) Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet II:526–530

    Google Scholar 

  3. Chesebro MD; Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J, Dodge HT, Francis CK, Hillis D, Lundbrook P, Markis JE, Mueller H, Passamani ER, Powers ER, Rao AK, Robertson T, Ross A, Ryan TJ, Sobel BE, Willerson J, Williams DO, Zaret BL, Braunwald E (1987) Thrombolysis in myocardial infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Circulation 76:142–154

    Google Scholar 

  4. Gore JM, Sloane M, Price TR, Young Randall AM (1991) Intracerebral hermorrhage, cerebral infarction and subdural hematoma after acute myocardial infarction and thrombolytic therapy in the thrombolysis in myocardial infarction study. Circulation 83:448–459

    Google Scholar 

  5. Simoons ML, for the investigators of the European Cooperative Study Group for Recombinant Tissue-Type Plasminogen Activator (rt-PA) (1988) Thrombolysis with Tissue Plasminogen Activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty. Lancet I:197–202

    Google Scholar 

  6. Van De Werf F, for the investigators of the European Cooperative Study Group for recombinant Tissue-Type Plasminogen Activator (1988) Lessons from the European recombinant tissue-type plasminogen activator versus placebo trial. J Am Coll Cardiol 12:14A-19A

    Google Scholar 

  7. O'Connor M, Califf RM, Massey EW, Mark DB, Kereiakes DJ, Candela RJ, Abbotsmith C, George B, Stack RS, Aronson L, Mantell S, Topol EJ (1990) Stroke and acute myocardial infarction in the thrombolytic era: clinical correlates and long-term prognosis. J Am Coll Cardiol 16:533–540

    Google Scholar 

  8. The International Study Group (1990) In-hospital mortality and clinical course of 20891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet II:71–75

    Google Scholar 

  9. Kase CS, O'Neal AM, Fisher M, Girgis GN, Ordia JI (1990) Intracranial hemorrhage after use of tissue plasminogen activator for coronary thrombolysis. Ann Intern Med 112:17–21

    Google Scholar 

  10. Althouse R, Maynard C, Olsufka M, Kennedy JW (1989) Risk factors for haemorrhage and ischemic stroke in myocardial infarction patients treated with tissue plasminogen activator. J Am Coll Cardiol 13:153A

    Google Scholar 

  11. Althouse R, Weaver WD, Kennedy JW (1987) Transient elevation of diastolic blood pressure in acute myocardial infarction. A contraindication to thrombolytic therapy. Circulation 76:306–309

    Google Scholar 

  12. Dabbs C, Aaberg T, Aguilar H, Sternberg P, Meredith T (1989) Complications of the treatment of severe fibrinous response following diabetic vitrectomy with tissue plasminogen activator. Invest Ophtalmol Vis Sci 30 [Suppl]:273

    Google Scholar 

  13. Nolan C, Beaty H (1976)Staphylococcus aureus bacteremia: current clinical patterns. Am J Med 60:495–499

    Google Scholar 

  14. Schlesinger L, Ross S, Schaberg D (1987)Staphylococcus aureus meningitis: a broad-based epidemiologic study. Medicine 66:148–155

    Google Scholar 

  15. Nahmias A, Whitley R, Vinsintine A (1982)Herpes simplex encephalitis: laboratory evaluation and their diagnostic significance. J Infect Dis 145:829–834

    Google Scholar 

  16. Mandell G, Gordon Douglas R, Bennett J (1990) Principles and practice of infectious diseases, 3rd edn. Churchill Livingstone, New York, pp 670 and 1489

    Google Scholar 

  17. Herzog C, Henry T, Zimmer S (1991) Bacterial endocarditis presenting as acute myocardial infarction: a cautionary note for the era of reperfusion. Am J Med 90:392–397

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reynard, C.A., Calain, P., Pizzolato, G.P. et al. Severe acute myocardial infarction during a staphylococcal septicemia with meningoencephalitis. Intensive Care Med 18, 247–249 (1992). https://doi.org/10.1007/BF01709842

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01709842

Key words

Navigation