Stroke, Vol 17, 179-185, Copyright © 1986 by American Heart Association
CR Hornig, W Dorndorf and AL Agnoli
In 65 cases of ischemic cerebral infarction, CT scans and quantitative
assessments of the neurological disturbances were undertaken at specific
intervals during the 4 week period after stroke. Forty-three patients
underwent lumbar puncture to determine the serum/CSF albumin ratio. The
etiology of the infarction was evaluated on the basis of angiographic,
ultrasonic and cardiologic findings. A hemorrhagic transformation of the
infarction occurred in 28 patients, eleven within the first week, and 15
within the second. Risks of hemorrhage were correlated with a severe
neurological deficit, disturbance of consciousness, large infarction with a
mass effect, enhancement of contrast medium in CT (especially if occurring
early), involvement of the cortex, and distinct blood/CSF barrier
disturbances. Cardiac embolism was a frequent etiology in patients with
secondary hemorrhagic infarction, especially when transformation occurred
within the first week after stroke. In addition to a heterogeneous pattern
of hemorrhage, frank hematoma predominated in those infarcts which
underwent early transformation, while those transforming late often showed
less hyperdense cortical hemorrhagic changes. Deterioration evident on
clinical evaluation was caused by the hemorrhagic transformation in three
cases, in each instance within the first week after stroke.
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Hemorrhagic cerebral infarction--a prospective study
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