Paradoxical Ischemic Stroke Following Streptokinase Fibrinolysis in STEMI: A Cardio-Cerebral Infarction Series from a Limited-Resource Setting

Authors

  • Wilbert Huang RSUD Natuna, Natuna, Riau Islands, Indonesia
  • Ryzufar Altarif Farsal RSUD Natuna, Natuna, Riau Islands, Indonesia
  • Harold J. M. Charlex RSUD Natuna, Natuna, Riau Islands, Indonesia
  • Hendrianus Hendrianus RSUD Natuna, Natuna, Riau Islands, Indonesia

DOI:

https://doi.org/10.30701/ijc.2135

Keywords:

fibrinolysis, STEMI, ischemic stroke, cardio-cerebral infarction, streptokinase

Abstract

Background: Ischemic stroke is a rare and paradoxical complication in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing fibrinolysis. Definitive diagnosis is challenging in a resource-limited setting.


Case Illustration: We report two cases of STEMI treated with streptokinase fibrinolysis in a setting where Percutaneous Coronary Intervention (PCI) was unavailable. The first patient presented with an inferior myocardial infarction and developed neurological symptoms 4 hours after fibrinolysis, including acute focal neurological deficits. Brain Computed Tomography (CT) demonstrated an acute lacunar infarction in the left pons. The second patient presented with an anterolateral myocardial infarction and developed a seizure during fibrinolysis treatment, in which the treatment was immediately terminated. Brain CT revealed a lacunar infarct in the left hypothalamus and calcification of the right Middle Cerebral Artery (MCA). In both cases, the lacunar pattern of infarction raised suspicion of ischemic stroke due to embolization of microthrombi following fibrinolysis of coronary or intracardiac thrombi, with subsequent migration to the cerebral circulation. The first patient subsequently deteriorated and died due to catastrophic multisystem bleeding, whereas the second patient showed no progression of neurological deficits.


Conclusions: Ischemic stroke following fibrinolytic therapy in patients with STEMI is an uncommon but serious complication that requires high clinical vigilance. Early recognition and individualized multidisciplinary management are essential to minimize neurological sequelae and optimize overall outcomes.

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Published

2026-10-25

How to Cite

Huang, W., Farsal, R. A., Charlex, H. J. M., & Hendrianus, H. (2026). Paradoxical Ischemic Stroke Following Streptokinase Fibrinolysis in STEMI: A Cardio-Cerebral Infarction Series from a Limited-Resource Setting. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.2135

Issue

Online First

Section

Case Reports

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