Hemorrhagic Transformation Within 36 Hours of a Cerebral Infarct

Abstract

Risk of early neurological deterioration and of 3-month death was severely increased after PH2, indicating that large hematoma is the only type of hemorrhagic transformation that may alter the clinical course of ischemic stroke.

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

“…ischaemic stroke [7,11,12], mainly due to the fact that haemorrhagic transformation is a frequent complication of thrombolysis or anticoagulant therapy. Previous studies have focused on the possible aetiological role of the following parameters: age [8,10,11,13,14], systolic and diastolic arterial blood pressure [14,15], congestive heart failure [11], body temperature [15], serum glucose level [8,14], treatment with anticoagulants [10,15], pre-treatment with aspirin [10,11], early ischaemic signs on CT [11,13,15], mean infarct volume [10,11,15], plasma matrix metalloproteinase-9 [15].…”

“…Haemorrhagic infarction is a frequent complication of ischaemic stroke [6][7][8], although it is not always accompanied by clinical deterioration [7][8][9][10]. The effect on clinical outcome is also unclear and most of the literature data regained from studies on thrombolysis for…”

Hemorrhagic Transformation after Ischemic Stroke in Animals and Humans

“…It occurs in as many as 10% to 40% of patients with ischemic stroke, 1,2 and is associated with increased stroke morbidity and mortality. [3][4][5] It is the major complication of tissue plasminogen activator (tPA), the only FDA-approved therapy for acute ischemic stroke. Thus, improved understanding of HT is essential to reduce its impact on patients with ischemic stroke and improve our ability to restore blood flow to ischemic brain without producing this complication.…”

“…Clinical studies frequently divide HT into four groups: small petechial hemorrhagic infarction (HI1), confluent petechial hemorrhagic infarction (HI2), small parenchymal hemorrhage (PH1) (o30% of infarct, mild mass effect), and large parenchymal hemorrhage (PH2, 430% of infarct, marked mass effect). 3 Hemorrhagic transformation is also often divided into symptomatic or asymptomatic groups based on the deterioration in neurologic status, defined as an increase in the National Institutes of Health Stroke Scale by 44 points within the first 36 hours of stroke onset. 6 These clinical classifications are useful in that larger hemorrhages are more likely symptomatic, more likely to negatively affect stroke outcomes, and thus are important to prevent.…”

“…6 These clinical classifications are useful in that larger hemorrhages are more likely symptomatic, more likely to negatively affect stroke outcomes, and thus are important to prevent. 3,5,7,8 However, even so-called 'asymptomatic' HT can worsen stroke outcomes, particularly when cognition and neurologic function are assessed weeks to months after stroke onset. 6,9 This may relate in part to exacerbation of cerebral edema and other toxic effects of blood produced by HT.…”