CT-detected hemorrhagic infarction; relation with the size of the infarct, and the presence of midline shift

Abstract

The incidence of mass effect indicated by midline shift, and the incidence of hemorrhagic infarction were studied in 952 consecutive CT scans with supratentorial infarcts. Hemorrhagic infarction was found in 5.1 % indicating that the incidence of hemorrhagic infarction during life is far less than was suggested from pathological studies. Midline shift was found in 3.6% and, accordingly, the chance of finding a hemorrhagic infarct with mass effect indicated by a shift of the midline would be 0.2% if these 2 phenomena were not related. However, this incidence appeared to be 12 times higher, indicating they are closely related. In addition, the incidence of hemorrhagic infarcts and midline shift were both related to large infarcts with bad outcome. Cardiac emboli were not more prevalent in patients with hemorrhagic infarcts than in a control series, indicating that cardiac emboli do not produce hemorrhagic infarction more often than other causes of cerebral infarction, and that cardiac embolic cause cannot be inferred from hemorrhagic infarction on CT. This probably also applies to carotid emboli. When anticoagulation is considered in patients with cerebral infarction, CT-confirmed hemorrhagic infarction and shift of midline structures as well as decreased consciousness are contraindications to such treatment. In their absence, and in the absence of general contraindications, anticoagulant treatment can safely be started.

Computed tomography diagnosis of eight dogs with brain infarction

“…In the present study of dogs, there was an equal number of ischaemic and hemorrhagic infarctions, which correlates with studies in humans, 21 but conflicts with a recent study of 40 dogs with brain infarction diagnosed by MRI in which all infarcts were classified non‐haemorrhagic 5 . Haemorrhagic lesions in our study were more likely to be associated with infarction having a mass effect, similar to findings in people 22 . It may be that MRI is more sensitive for detecting haemorrhagic infarcts not associated with a mass effect, causing this discrepancy, or the result may be attributable to the low number of cases in our study.…”

“…5 Haemorrhagic lesions in our study were more likely to be associated with infarction having a mass effect, similar to findings in people. 22 It may be that MRI is more sensitive for detecting haemorrhagic infarcts not associated with a mass effect, causing this discrepancy, or the result may be attributable to the low number of cases in our study.…”

Frequency and Determinants for Hemorrhagic Transformation of Cerebral Infarction

“…Resolution capacity of CT scanner in 1984 was less sensitive [8] than that of more recent generation scanners. Moreover, studies using MRI to detect HT [6,7] reported a higher incidence of HT compared to those using CT [3,[8][9][10][11][12][13][14][15][16][17][18][19] . Risk of HT increases with the strength of treatment (antithrombotic, anticoagulant, thrombolytic) [1] and, as cardioembolic stroke is related to a greater risk of HT, studies including only cardioembolic stroke [10] might overestimate HT frequency.…”

Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome

“…[2][3][4][5][6][7][8][9][10][11] Furthermore, most of the information on the effect of early HT on clinical outcomes derives from studies on thrombolysis for ischemic stroke, [12][13][14][15][16] and data on early HT in patients not receiving thrombolysis mainly derives from patients randomized to placebo in the thrombolysis trials. 17,18 The aims of this prospective study in consecutive patients were therefore to assess: (1) the rate of early HT in patients admitted for ischemic stroke, (2) the correlation between early HT and functional outcome at 3 months, and (3) the risk factors for early HT.…”