Stroke. 2002;33:95-98
doi: 10.1161/hs0102.101792
doi: 10.1161/hs0102.101792
(Stroke. 2002;33:95.)
© 2002 American Heart Association, Inc.
Original Contributions |
Magnetic Resonance Imaging Detection of Microbleeds Before Thrombolysis
An Emerging Application
From the UCLA Stroke Center (C.S.K., J.L.S., J.P.V., G.D., K.G., M.C.L., S.S., Y.P.G., R.J., P.V., J.R.A., F.V.) and Departments of Neurology (C.S.K., J.L.S., A.F., K.G., M.C.L., S.S., P.V.), Radiological Sciences (J.P.V., G.D., Y.P.G., R.J., J.R.A., F.V.), Emergency Medicine (S.S.), and Neurological Surgery (P.V.), UCLA Medical Center, Los Angeles, Calif, and Comprehensive Stroke Center and Department of Neurology (D.S.L.), University of Pennsylvania, Philadelphia, Pa.
Correspondence to Chelsea S. Kidwell, MD, UCLA Stroke Center, 710 Westwood Plaza, UCLA Medical Center, Los Angeles, CA 90095. E-mail ckidwell{at}ucla.edu
Background— Hemorrhagic transformation (HT) is a major complication of thrombolytic treatment for acute ischemic stroke. Although a history of prior intracerebral hemorrhage diagnosed by head CT is a contraindication to thrombolysis, there are no guidelines or data regarding evidence of prior asymptomatic microbleeds visualized with T2*-weighted magnetic resonance imaging (MRI).
Methods— Pretreatment T2*-weighted MRI sequences were retrospectively analyzed in all patients receiving intra-arterial thrombolytic therapy and undergoing a pretreatment MRI at our institution. The frequency and location of prior microbleeds was determined and compared with the frequency and location of secondary HT after therapy.
Results— Five of 41 patients undergoing MRI before receiving intra-arterial thrombolytic therapy demonstrated evidence of prior microbleeds on the pretreatment MRI studies. Major symptomatic hemorrhage occurred in 1 of 5 patients with microbleeds compared with 4 of 36 patients without. Only 1 patient in the entire 41-patient cohort experienced any HT outside the acute ischemic field. In this patient, the symptomatic hemorrhage occurred directly at the site of a prior microbleed, contralateral to the acute ischemic event.
Conclusions— Old silent microbleeds, visualized with T2*-weighted MRI sequences, may be a marker of increased risk of HT in patients receiving thrombolytic therapy for acute ischemic stroke. Pretreatment screening of thrombolytic candidates with these MRI sequences may be useful in the future to identify these patients.
Key Words: hemorrhage • magnetic resonance imaging • stroke, acute • stroke, ischemic • thrombolysis
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|
|
|
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|
|
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|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 D. C.C. Johnston and M. D. Hill The patient with transient cerebral ischemia: a golden opportunity for stroke prevention Can. Med. Assoc. J., March 30, 2004; 170(7): 1134 - 1137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Linfante Editorial Comment--Can MRI Reliably Detect Hyperacute Intracerebral Hemorrhage? Ask the Medical Student Stroke, February 1, 2004; 35(2): 506 - 507. [Full Text] [PDF]
|
|
|
|
|
|
J. B. Fiebach, P. D. Schellinger, A. Gass, T. Kucinski, M. Siebler, A. Villringer, P. Olkers, J. G. Hirsch, S. Heiland, P. Wilde, et al. Stroke Magnetic Resonance Imaging Is Accurate in Hyperacute Intracerebral Hemorrhage: A Multicenter Study on the Validity of Stroke Imaging Stroke, February 1, 2004; 35(2): 502 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 N. Dudley Be careful when extrapolating trial data to real life BMJ, October 4, 2003; 327(7418): 812 - 812. [Full Text]
|
|
|
|
|
|
Y. H. Fan, L. Zhang, W. W.M. Lam, V. C.T. Mok, and K. S. Wong Cerebral Microbleeds as a Risk Factor for Subsequent Intracerebral Hemorrhages Among Patients With Acute Ischemic Stroke Stroke, October 1, 2003; 34(10): 2459 - 2462. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. Packard, C. S. Kase, A. S. Aly, and G. D. Barest "Computed Tomography-Negative" Intracerebral Hemorrhage: Case Report and Implications for Management Arch Neurol, August 1, 2003; 60(8): 1156 - 1159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, J. B. Fiebach, K. Hoffmann, K. Becker, B. Orakcioglu, R. Kollmar, E. Juttler, P. Schramm, S. Schwab, K. Sartor, et al. Stroke MRI in Intracerebral Hemorrhage: Is There a Perihemorrhagic Penumbra? Stroke, July 1, 2003; 34(7): 1674 - 1679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. D. Vo, F. Santiago, W. Lin, C. Y. Hsu, Y. Lee, and J.-M. Lee MR Imaging Enhancement Patterns as Predictors of Hemorrhagic Transformation in Acute Ischemic Stroke AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 674 - 679. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. von Kummer MRI: The New Gold Standard for Detecting Brain Hemorrhage? Stroke, July 1, 2002; 33(7): 1748 - 1749. [Full Text] [PDF]
|
|
|
|
|
|
S. Coutts, R. Frayne, R. Sevick, and A. Demchuk Microbleeding on MRI as a Marker for Hemorrhage After Stroke Thrombolysis Stroke, June 1, 2002; 33(6): 1457 - 1458. [Full Text] [PDF]
|
|
|
|
|
|
C. S. Kidwell, J. L. Saver, J. Carneado, J. Sayre, S. Starkman, G. Duckwiler, Y.P. Gobin, R. Jahan, P. Vespa, J.P. Villablanca, et al. Predictors of Hemorrhagic Transformation in Patients Receiving Intra-Arterial Thrombolysis * Editorial Comment Stroke, March 1, 2002; 33(3): 717 - 724. [Abstract] [Full Text] [PDF]
|
|