Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes

Abstract

ObjectivesWe performed this retrospective cohort study to establish which factors are mostly indicative of the appearance of hemorrhagic transformation (HT) and of its time course in a sample of nonlacunar ischemic strokes.Materials and MethodsIn 402 patients with nonlacunar ischemic stroke (75.0 ± 12.7 years, 192 male), clinical, laboratory, and neuroimaging variables obtained during the first 3 days of hospitalization were compared between patients with and without HT at computer tomography scan.ResultsHT was documented in 129 patients (32.1%), including 36 with parenchymal hematoma (PH), after a median time of 6 days (range 1–27). Many variables were univariately associated with HT, but only 5 of them were confirmed in Cox regression (Hazard Ratio, 95% Confidence Interval): maximum cerebral lesion diameter (CLD) in cm (1.12, 1.06–1.18; p = .0001), hemoglobin in g/dl (1.16, 1.06–1.27; p = .002), blood glucose in mmol/L (1.10, 1.03–1.18; p = .007), prior anticoagulant therapy (1.82, 1.10–3.03; p = .02), and edema with mass effect (1.72, 1.08–2.75; p = .02). Thus, the most significant predictor was CLD. The overall risk of HT was minimum for CLD < 2 cm (1.5%), intermediate for CLD ≥ 2 and < 5 cm (22%), and maximum for CLD ≥ 5 cm (58%). The residual probability of having HT decreased progressively over time, and a simple formula is proposed to predict, from CLD in cm, when the probability of HT falls below 10%.ConclusionsThe main determinant of HT was CLD, a simple quantitative parameter that could prove useful, in particular, in deciding the timing of anticoagulation in cardioembolic stroke patients.

Prognostic significance of diabetes and stress hyperglycemia in acute stroke patients

“…In fact, inflammation can increase blood–brain barrier permeability and can damage the white matter [ 16 , 35 ]. An association between hyperglycemia and hemorrhagic transformation had previously been found by others [ 36 ] and also by us, previously [ 37 ] and in the present study. However, the factor by far most associated with hemorrhagic transformation is the size of cerebral lesion [ 37 ], and this may partly explain why we did not find a direct association with hemorrhagic transformation in Group 3, despite the fact that glucose levels in that group were even higher than in Group 1.…”

A Review of Risk Factors and Predictors for Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

“…Although HT can occur at various timeframes, it typically occurs within the first week after AIS. A retrospective cohort study performed by Muscari et al showed a median of 6 days with a range of 1-27 days [30]. HT is, sometimes, further divided into early HT, <48 hours, and late HT, >48 hours, in literature [31][32][33].…”

Recurrent Hemorrhagic Transformation of Cardioembolic Stroke in an Elderly Patient: A Case Report and Literature Review

“…Besides cardioembolism, the patient has multiple other risk factors of HT, including advanced age, hyperglycemia, hypertension, and hypodensity on head CT [3,[5][6][7][8][9]. The patient has severe WMH, where the underlying pathological changes included hyaline arteriolosclerosis, hyperplastic arteriolosclerosis, or possible cerebral amyloid angiopathy (CAA), added the risks of intracerebral hemorrhage [22].…”

“…The frequency of HT was reported to be around 9%. The risk factors of HT include large reperfusion, embolic infarcts, age older than 70 years, renal insufficient, anticoagulant therapy, hypertension, and low low-density lipoprotein (LDL) cholesterol [3,[5][6][7][8][9].…”