Stroke, Vol 20, 598-603, Copyright © 1989 by American Heart Association
Y Okada, T Yamaguchi, K Minematsu, T Miyashita, T Sawada, S Sadoshima, M Fujishima and T Omae
We studied the mechanism of hemorrhagic infarction after acute cerebral
embolism in 160 patients by brain computed tomography and angiography.
Hemorrhagic infarction during the month after the embolic event was evident
in 65 patients (40.6%). Initial angiography a median of 1.5 (range 1-60)
days after the event revealed occlusion of the cerebral arteries in 117 of
142 patients (82.4%), and reopening of the vessels was observed in 56
(94.9%) of 59 patients who had follow-up angiography a median of 20 (range
3-47) days after the event. The incidence of hemorrhagic infarction was
higher in patients greater than or equal to 70 years old (31 of 61, 50.8%)
than in those aged 50-69 years (27 of 72, 37.5%) or less than 50 years
(seven of 27, 25.9%) (greater than or equal to 70 vs. less than 50, p less
than 0.05). In patients with moderate or large infarcts, hemorrhagic
infarction developed in 50.0% or 51.5%, respectively, while in those with
small infarcts it developed in only 2.9% (p less than 0.05). No correlation
was found between hemorrhagic infarction and history of hypertension or
blood pressure during the acute stage of stroke. Thrombolytic and/or
anticoagulant therapy did not affect the incidence of hemorrhagic
infarction (40.0% with vs. 40.7% without therapy) but tended to cause
massive hematoma. Our results indicate that hemorrhagic transformation in
cerebral embolism is caused not only by reopening of the occluded vessels
but also by other factors such as age and size of the infarct. Hypertension
per se seems to be less important for hemorrhagic infarction.(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Hemorrhagic transformation in cerebral embolism
Department of Internal Medicine, National Cardiovascular Center, Suita City, Japan.
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