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(Stroke. 2006;37:2463.)
© 2006 American Heart Association, Inc.

Original Contributions

Leukoaraiosis Is a Risk Factor for Symptomatic Intracerebral Hemorrhage After Thrombolysis for Acute Stroke

Tobias Neumann-Haefelin, MD; Silke Hoelig; Joachim Berkefeld, MD; Jens Fiehler, MD; Achim Gass, MD; Marek Humpich, MD; Andreas Kastrup, MD; Thomas Kucinski, MD; Olivera Lecei, MD; David S. Liebeskind, MD; Joachim Rother, MD; Charlotte Rosso, MD; Yves Samson, MD; Jeffrey L. Saver, MD; Bernhard Yan, MD for the MR Stroke Group

From the Klinik für Neurologie (T.N.-H., S.H., M.H.) and Institut für Neuroradiologie (J.B., B.Y.), Universitätsklinik, Goethe Universität, Frankfurt, Germany; Neuroradiologie (J.F., T.K.), Universitätsklinik Eppendorf, Hamburg, Germany; Neurologische Klinik (A.G., O.L.), Universitätsklinikum, Mannheim, Germany; Neurologische Klinik (A.K.), Universitätsklinikum, Jena, Germany; UCLA Stroke Center (D.S.L., J.L.S.), University of California, Los Angeles; Neurologische Klinik (J.R.), Klinikum Minden, Minden, Germany; and Urgences Cérébro-Vasculaires (C.R., Y.S.), Salpêtrière, AP-HP, Paris, France.

Correspondence to Dr Tobias Neumann-Haefelin, Klinik für Neurologie, ZNN, Klinikum der Goethe-Universität, Schleusenweg 2-16, 60528 Frankfurt, Germany. E-mail tnh{at}rz.uni-frankfurt.de

Background and Purpose— The aim of the study was to evaluate whether leukoaraiosis (LA) is a risk factor for symptomatic intracerebral hemorrhage (sICH) in patients treated with thrombolysis for acute stroke.

Methods— In this retrospective, multicenter analysis, we evaluated data from acute anterior circulation stroke patients (n=449; <6 hours after symptom onset) treated with thrombolysis. All patients had received standard magnetic resonance imaging evaluation before thrombolysis, including a high-quality T2-weighted sequence. For the analysis, LA in the deep white matter was dichotomized into absent or mild versus moderate or severe (corresponding to Fazekas scores of 0 to 1 versus 2 to 3).

Results— The rate of sICH was significantly more frequent in patients with moderate to severe LA of the deep white matter (n=12 of 114; 10.5%) than in patients without relevant LA (n=13 of 335; 3.8%), corresponding to an odds ratio of 2.9 (95% CI, 1.29 to 6.59; P=0.015). In a logistic-regression analysis (including age, National Institutes of Health Stroke Scale score at presentation, and type of thrombolytic treatment), LA remained a significant independent risk factor (odds ratio, 2.9; P=0.03).

Conclusions— LA of the deep white matter is an independent risk factor for sICH after thrombolytic treatment for acute stroke.

Key Words: intracerebral hemorrhage • leukoaraiosis • stroke, acute • thrombolysis

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