Recurrence of embolic stroke during intravenous thrombolysis

An 81-year-old man with atrial fibrillation presented with embolic stroke in the right middle cerebral artery. During intravenous thrombolysis, he became comatose and developed a recurrent embolism in the top of the basilar artery. Intra-arterial mechanical disruption of the embolus failed to recanalize. Laboratory studies on admission demonstrated thrombocytosis, but echocardiography performed after thrombolysis did not identify an embolic source, including mural thrombi.