Haemorrhagic transformation of acute cerebral ischaemia on CT

  • S. Bastianello
  • D. Toni
  • M. L. Sacchetti
  • M. Fiorelli
  • M. Rasura
  • C. Argentino
  • L. M. Fantozzi
  • C. Fieschi
  • L. Bozzao
Conference paper

Abstract

In a continuous series of 132 patients with ischaemic stroke studied in the acute phase, we assessed the occurrence and CT appearances of haemorrhagic transformation (HI) related to clinical outcome. Fiftyseven patients (43%) developed HI (only 3 had parenchymal haemorrhage). On the first CT, early signs of an ischaemic lesion were more frequent in HI (93%) than in non-HI (20%) (P<0.0001). Patients with early CT lowdensity showed a worse outcome in 74% of cases (17 dead and 33 poor outcome) compared with patients with a negative CT scan on admission, of whom 59% had a good outcome (P < 0.0002). Clinical outcome in the HI patients group was impaired to the same extent, showing a worse outcome in 78% of cases (14 dead and 30 poor outcome) compared with the non-HI group of which 57% had a good outcome (P< 0.0002). We showed a high frequency of HI in patients with stroke and documented that the haemorrhagic transformation of ischaemic stroke did not directly influence the clinical outcome, while early CT ischaemic signs may be the main predictors of both HI and clinical outcome.

key words

Cerebral ischaemia Haemorrhagic transformation Computed tomography 

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References

  1. 1.
    Ott BR, Zamani A, Kleefield J, Funkenstein HH (1986) The clinical spectrum of hemorrhagic infarction. Stroke 17: 630–637.PubMedCrossRefGoogle Scholar
  2. 2.
    Fisher M, Zito JL, Siva A, DeGirolami U (1984) Hemorrhagic infarction: a clinical and CT study. Stroke 15: 192.CrossRefGoogle Scholar
  3. 3.
    Jorgensen L, Torvik A (1969) Ischemic cerebrovascular disease in an autopsy series, part II. J Neurol Sci 9: 285–320.PubMedCrossRefGoogle Scholar
  4. 4.
    Yamaguchi T, Minematsu K, Choki J, Sawada T, Ikeda M (1984) Clinical and neuroradiological analysis of thrombotic and embolie cerebral infarction. Jpn Circ J 48: 50–58.PubMedCrossRefGoogle Scholar
  5. 5.
    Pessin MS, Estol CJ, Lafranchise EF, Caplan LR (1991) Safety of anticoagulation in hemorrhagic infarction. Stroke 41: 346.Google Scholar
  6. 6.
    Pessin MS, Del Zoppo GJ, Estol CJ (1990) Thrombolytic agents in the treatment of stroke. Clin Neuropharmacol 13: 271–289.PubMedCrossRefGoogle Scholar
  7. 7.
    TherTPA/Acute Study Group (1991) An open safety/efficacy trial of rT PA in acute thrombolytic stroke: final report. Stroke 22: 153Google Scholar
  8. 8.
    Von Kummer R, Forsting M, Sartor K, Hacke W (1991) Intravenous plasminogen activator in acute stroke. In: Hacke W, Del Zoppo GJ, Hirschberg M (eds) Thrombolytic therapy in acute ischemic stroke. Springer New York Berlin Heidelberg, pp 161-167.Google Scholar
  9. 9.
    Tomura N, Uemura K, Inugami A, Fujita H, Higano S, Shishido F (1988) Early CT finding in cerebral infarction. Radiology 168: 463–467.PubMedGoogle Scholar
  10. 10.
    Bozzao L, Bastianello S, Fantozzi LM, Angeloni U, Argentino C, Fieschi C (1989) Correlation of angiographie and sequential CT findings in patients with evolving cerebral infarction. AJNR 10: 1215–1222.PubMedGoogle Scholar
  11. 11.
    Tomsick TA, Brott TG, Chambers AA, et al (1990) Hyperdense middle cerebral artery sign on CT: efficacy in detecting middle cerebral artery thrombosis. AJNR 11: 473–477.PubMedGoogle Scholar
  12. 12.
    Bastianello S, Pierallini A, Colonnese C, et al (1991) Hyperdense middle cerebral artery CT sign. Comparison with angiography in the acute phase of ischaemic supratentorial infarction. Neuroradiology 33: 207–211.PubMedCrossRefGoogle Scholar
  13. 13.
    Yamaguchi T, Hayakawa T, Kikuchi H, Abe T (1991) Thrombolytic therapy in embolie and thrombotic cerebral infarction: a cooperative study. In: Hacke W, Del Zoppo GJ, Hirschberg M (eds) Thrombolytic therapy in acute ischemic stroke. Springer New York Berlin Heidelberg, pp 168-174.Google Scholar
  14. 14.
    Bozzao L, Angeloni U, Bastianello S, Fantozzi LM, Pierallini A, Fieschi C (1991) Early angiographie and CT findings in patients with hemorrhagic infarction in the distribution of the middle cerebral artery. AJNR 12: 1115–1121.PubMedGoogle Scholar
  15. 15.
    Adams RD, Van der Eecken HM (1953) Vascular disease of the brain. Annu Rev Med 14: 213–252.CrossRefGoogle Scholar
  16. 16.
    Hart RG, for Cerebral Embolism Study Group (1986) Timing of hemorrhagic transformation of cardioembolic stroke. In: Stober T, Schimrigk K, Ganten D, Sherman DG (eds) Central nervous system control of the heart. Nijhoff, Boston, pp 229-232.Google Scholar
  17. 17.
    Bozzao L, Fantozzi LM, Bastianello S, Bozzao A, Fieschi C (1989) Early collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion. Stroke 6: 735–740.CrossRefGoogle Scholar
  18. 18.
    Van der Eecken HM, Adams RD (1953) The anatomy and functional significance of the meningeal arterial anastomoses of the human brain. J Neuropathol Exp Neurol 12: 132–157.CrossRefGoogle Scholar
  19. 19.
    Horowitz SH, Zito JL, Donnarumma R, Patel M, Alvir J (1991) Computed tomographic — angiographic findings within the first five hours of cerebral infarction. Stroke 22: 1245–1253.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1995

Authors and Affiliations

  • S. Bastianello
    • 1
  • D. Toni
    • 1
  • M. L. Sacchetti
    • 1
  • M. Fiorelli
    • 1
  • M. Rasura
    • 1
  • C. Argentino
    • 1
  • L. M. Fantozzi
    • 1
  • C. Fieschi
    • 1
  • L. Bozzao
    • 1
  1. 1.Department of NeuroradiologyUniversity of Rome “La Sapienza”RomeItaly

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