. Case 1
A 63-year-old man with dyslipidemia and Pemphigus was
admitted to undergo his eleventh monthly IVIg cycle. Immediately
after the end of the fifth day of infusion, with Octagam® 26 mg, which
was administered at a higher velocity rate than recommended in the
protocol, a language disturbance was noticed. Neurological examination
disclosed dysphasia, right hemiparesis and hemisensory loss.
Brain computerized tomography (CT) scan was unremarkable. rtPA
perfusion was started 195 min after symptoms onset, with a total
alteplase of 53.1 mg (0.9 mg/kg). After perfusion, neurological deficits persisted. Blood pressure never went beyond 187 mm Hg systolic and
105 mm Hg diastolic. Next day, he had new left homonymous
hemianopia. Brain CT showed an ischemic lesion in the left middle
cerebral artery (LMCA) territory and bilateral intracerebral hematomas
(Fig. 1a). Brain magnetic resonance imaging (MRI) performed
7 days after stroke onset disclosed the previous reported lesions
without evidence of further lesions (DWI, T2*). Remaining etiological
examinations were unremarkable (coagulation studies, carotid and
transcranial Doppler, transthoracic echocardiogram, 24-hours ECG).