Symptoms of intracranial bleeding following thrombolysis include which of the following as a common presentation?

• A. Pupillary changes
• B. Change in LOC
• C. New headache
• D. Acute neurological deterioration

Answer: (D)

Intracranial bleeding after thrombolysis tends to manifest as a sudden deterioration in neurological status. When bleeding occurs inside the skull, brain function can rapidly worsen, leading to new or worsening deficits and a drop in level of consciousness. This abrupt change is the most consistent and urgent sign that bleeding may be present, making acute neurological deterioration the best descriptor among the options.

Pupil changes and a new headache can occur, but they’re less specific and not as reliably indicative on their own. A change in level of consciousness can happen with many conditions, whereas a rapid, overall decline in neurological function directly points to a bleed impacting brain activity and thus warrants immediate imaging and intervention.