A 69-year-old male with no significant past medical history presented to our facility for left-sided hemiplegia, hemisensory loss, neglect, dysarthria and right gaze preference (National Institute of Health Stroke Scale 22). He was last seen normal three hours prior to presentation. An emergent noncontrast Computerized Tomography (CT) scan of the head showed hypo-attenuation in the right parietal lobe and  IV thrombolysis was administered.

Subsequently the patient was noted with abnormal motor activity of his left side, left gaze preference and left-beating nystagmus. He was given IV lorazepam and levetiracetam for suspected seizure activity. An emergent Electroencephalogram showed periodic lateralized epileptiform discharges over the right cerebral hemisphere.

Following IV thrombolysis, the patient had CT angiogram which revealed no large vessel occlusion however a marginally enhancing, and centrally nonenhancing mass within the right parietal lobe with vasogenic edema was elucidated. Repeated noncontrast CT head 24 hours after thrombolytic therapy revealed no evidence of intracerebral hemorrhage. Magnetic Resonance Imaging of the brain with gadolinium revealed a 2.5 cm ring-enhancing mass in the right parietal lobe. The patient underwent right sided craniotomy with resection of the mass and pathology revealed Glioblastoma, IDH-wildtype with MGMT promoter methylation.

Our case suggests that thrombolysis inadvertently administered to a stroke mimic may be potentially safe in patients with high-grade gliomas and acceptable medical comorbidities and performance status. This underlines the need for further prospective studies for validation of this observation.