{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T19:55:58Z","timestamp":1772999758028,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Central nervous system (CNS) hemorrhage is a serious complication of intravenous thrombolysis. Tenecteplase, a fibrin\u2010specific thrombolytic agent, has a lower risk of hemorrhage than other agents. We report the first documented case of simultaneous intracranial and spinal hemorrhage following intravenous administration of tenecteplase. A 55\u2009year old Sri Lankan woman presented with ischemic chest pain and was diagnosed with an acute inferior ST\u2010elevation myocardial infarction (STEMI). She was treated with oral aspirin, clopidogrel, atorvastatin, intravenous enoxaparin, tenecteplase (30\u2009mg), and subcutaneous enoxaparin. Two hours after successful thrombolysis, she developed acute paraparesis with a sensory level at the fourth thoracic segment. A CT angiogram ruled out aortic dissection, but an MRI spine revealed a posterior extradural hemorrhage extending from the C4 to S1 vertebrae, and long segment of T2\u2010weighted hyperintensity of the spinal cord with prominent gray matter involvement, consistent with compressive myelopathy. There was no evidence of pre\u2010existing arteriovenous malformations, cavernoma, or coagulopathy. Additionally, a non\u2010contrast CT of the brain performed due to headache revealed an intracranial hemorrhage in the left frontal lobe, although this was not associated with focal neurological deficits. Antiplatelet therapy and enoxaparin were discontinued. The patient developed cardiogenic shock and died 8\u2009days later. In conclusion, tenecteplase can result in concurrent CNS hemorrhages even in the absence of vascular anomalies or coagulation defects. Clinicians should remain vigilant for both cranial and spinal hemorrhagic complications even with fibrin\u2010specific agents like tenecteplase.<\/jats:p>","DOI":"10.1002\/ccr3.71840","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T04:36:39Z","timestamp":1769661399000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Simultaneous Intracranial and Spinal Hemorrhage Following Tenecteplase Thrombolysis for\n                    <scp>ST<\/scp>\n                    \u2010Elevation Myocardial Infarction: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"given":"Thamalee","family":"Palliyaguru","sequence":"first","affiliation":[{"name":"Professorial Unit in Medicine National Hospital of Sri Lanka  Colombo Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7037-2553","authenticated-orcid":false,"given":"Pramith","family":"Ruwanpathirana","sequence":"additional","affiliation":[{"name":"Professorial Unit in Medicine National Hospital of Sri Lanka  Colombo Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Praveen","family":"Weeratunga","sequence":"additional","affiliation":[{"name":"Professorial Unit in Medicine National Hospital of Sri Lanka  Colombo Sri Lanka"},{"name":"Department of Clinical Medicine, Faculty of Medicine University of Colombo  Colombo Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mythily","family":"Aravinthan","sequence":"additional","affiliation":[{"name":"Professorial Unit in Medicine National Hospital of Sri Lanka  Colombo Sri Lanka"},{"name":"Department of Clinical Medicine, Faculty of Medicine University of Colombo  Colombo Sri Lanka"},{"name":"Flinders Medical Centre  Bedford Park South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thashi","family":"Chang","sequence":"additional","affiliation":[{"name":"Professorial Unit in Medicine National Hospital of Sri Lanka  Colombo Sri Lanka"},{"name":"Department of Clinical Medicine, Faculty of Medicine University of Colombo  Colombo Sri Lanka"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12872\u2010024\u201004121\u20105"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A7862"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/bc.bc_17_21"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/239796"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2003.026757"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1301092"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30253-3"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)70017-7"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1109842"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2009.04.016"},{"issue":"6","key":"e_1_2_14_12_1","first-page":"448","article-title":"Spinal 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Myocardial Infarction","volume":"91","author":"Agu\u00fcero\u2010Castrell\u00f3n M.","year":"2021","journal-title":"Archivos de Cardiolog\u00eda de M\u00e9xico"},{"issue":"1","key":"e_1_2_14_19_1","first-page":"191","article-title":"Spontaneous Epidural Hematoma of the Cervical Spine Following Thrombolysis in a Patient With STEMI\u2014Two Medical Specialties Facing a Rare Dilemma","volume":"11","author":"Tsarouchas A.","year":"2019","journal-title":"Journal of Neuroscience Rural Practice"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.1159\/000313637"},{"issue":"1","key":"e_1_2_14_21_1","first-page":"A1","article-title":"2650 Spinal Epidural Hematoma Following Thrombolysis as a Stroke Mimic","volume":"5","author":"Yagnik D.","year":"2023","journal-title":"BMJ Neurology 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