Background: Postoperative acute ischemic stroke may be associated with significant morbidity and mortality. Available treatment options have been limited because of concern about the risk for substantial postoperative bleeding. Data regarding the safety and use of intravenous (I.V.) thrombolysis in postoperative patients has been sparse. Case: A 62-year-old postmenopausal female had an acute ischemic stroke that occurred <1 hour after surgical excision of a vaginal mass. Administration of I.V. alteplase ∼3.5 hours following the onset of this cerebrovascular accident resulted in complete resolution of symptoms. Bleeding from the surgical site was minimal. Results: To date, this patient has no permanent neurologic deficit secondary to her perioperative acute ischemic stroke. Conclusions: With close surveillance in carefully selected patients, I.V. thrombolysis may be a viable treatment option for acute ischemic stroke following low-risk gynecologic surgical procedures. (J GYNECOL SURG 32:201)
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