(Stroke. 1999;30:761-764.)
© 1999 American Heart Association, Inc.
Original Contributions |
Hemorrhage After an Acute Ischemic Stroke
From the Istituto di Clinica Neurologica, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico (C.M., A.C., E.A., A.P., L.C.) and the Servizio di Neuroradiologia, Ospedale "Niguarda-Cà Granda" (E.B., C. De G.) Milan, Italy.
Correspondence to Livia Candelise, MD, Istituto di Clinica Neurologica, Università degli Studi di Milano, Ospedale Maggiore Policlinico, IRCCS, Via F. Sforza 35, 20122 Milano, Italia. E-mail pitagora{at}imiucca.csi.unimi.it
Background and Purpose—Hemorrhagic transformation is frequently seen on CT scans obtained in the subacute phase of ischemic stroke. Its prognostic value is controversial.
Methods—We analyzed 554 patients with acute ischemic stroke enrolled in the Multicenter Acute Stroke Trial–Italy (MAST-I) study in whom a second CT scan was performed on day 5. Presence of 1) intraparenchymal hemorrhages (hematoma or hemorrhagic infarction), 2) extraparenchymal bleeding (intraventricular or subarachnoid) and 3) cerebral edema (shift of midline structure, sulcal effacement or ventricular compression) alone or in association were evaluated. Death or disability at 6 months were considered as "unfavorable outcome."
Results—Patients who developed intraparenchymal
hemorrhages, extraparenchymal bleeding, or cerebral edema had
unfavorable outcome (83%, 100%, and 80%, respectively), but
multivariate analysis demonstrated that only
extraparenchymal bleeding (collinearity) and cerebral edema (OR=6.8;
95% CI, 4.5 to 10.4) were significant independent prognostic findings.
Unfavorable outcome correlated with size of intraparenchymal
hemorrhage (
2 for trend=30.5,
P<0.0001). Nevertheless, when a large hematoma was
present the negative effect was mostly due to concomitant
extraparenchymal bleeding (2=51.6,
P<0.0001), and when hemorrhagic infarction was detected
the negative effect was mostly explained by the association with
cerebral edema (2=36.6, P<0.0001).
Conclusions—Extraparenchymal bleeding and cerebral edema are the main prognostic CT scan findings in the subacute phase of ischemic stroke. Stroke patients with a high risk for developing these 2 types of brain damage should be identified. Measures to prevent and adequately treat their development should be implemented.
Key Words: hemorrhage • prognosis • stroke, acute • tomography, x-ray computed
This article has been cited by other articles:
 |
|
 |
|
  D. Summers, A. Leonard, D. Wentworth, J. L. Saver, J. Simpson, J. A. Spilker, N. Hock, E. Miller, P. H. Mitchell, and on behalf of the American Heart Association Counci Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement From the American Heart Association Stroke, August 1, 2009; 40(8): 2911 - 2944. [Full Text] [PDF]
|
|
|
|
|
|
M. Paciaroni, G. Agnelli, F. Corea, W. Ageno, A. Alberti, A. Lanari, V. Caso, S. Micheli, L. Bertolani, M. Venti, et al. Early Hemorrhagic Transformation of Brain Infarction: Rate, Predictive Factors, and Influence on Clinical Outcome: Results of a Prospective Multicenter Study Stroke, August 1, 2008; 39(8): 2249 - 2256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Thuny, J.-F. Avierinos, C. Tribouilloy, R. Giorgi, J.-P. Casalta, L. Milandre, A. Brahim, G. Nadji, A. Riberi, F. Collart, et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: a prospective multicentre study Eur. Heart J., May 1, 2007; 28(9): 1155 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Mullins, M. H. Lev, D. Schellingerhout, R. G. Gonzalez, and P. W. Schaefer Intracranial Hemorrhage Complicating Acute Stroke: How Common Is Hemorrhagic Stroke on Initial Head CT Scan and How Often Is Initial Clinical Diagnosis of Acute Stroke Eventually Confirmed? AJNR Am. J. Neuroradiol., October 1, 2005; 26(9): 2207 - 2212. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. H. Schwamm, E. S. Rosenthal, C. J. Swap, J. Rosand, G. Rordorf, F. S. Buonanno, M. G. Vangel, W. J. Koroshetz, and M. H. Lev Hypoattenuation on CT Angiographic Source Images Predicts Risk of Intracerebral Hemorrhage and Outcome after Intra-Arterial Reperfusion Therapy AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1798 - 1803. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R Meijer, J van Limbeek, G Peusens, M Rulkens, K Dankoor, M Vermeulen, and R J de Haan The Stroke unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study Clinical Rehabilitation, July 1, 2005; 19(7): 770 - 778. [Abstract] [PDF]
|
|
|
|
|
|
D. M. Kent, J. Hinchey, L. L. Price, S. R. Levine, and H. P. Selker In Acute Ischemic Stroke, Are Asymptomatic Intracranial Hemorrhages Clinically Innocuous? Stroke, May 1, 2004; 35(5): 1141 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Huang and R. L. Robertson Spontaneous Superficial Parenchymal and Leptomeningeal Hemorrhage in Term Neonates AJNR Am. J. Neuroradiol., March 1, 2004; 25(3): 469 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.J. Anderson, L.B. Goldstein, W.E. Wilkinson, G.R. Corey, C.H. Cabell, L.L. Sanders, and D.J. Sexton Stroke location, characterization, severity, and outcome in mitral vs aortic valve endocarditis Neurology, November 25, 2003; 61(10): 1341 - 1346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. P. Adams Jr, R. J. Adams, T. Brott, G. J. del Zoppo, A. Furlan, L. B. Goldstein, R. L. Grubb, R. Higashida, C. Kidwell, T. G. Kwiatkowski, et al. Guidelines for the Early Management of Patients With Ischemic Stroke: A Scientific Statement From the Stroke Council of the American Stroke Association Stroke, April 1, 2003; 34(4): 1056 - 1083. [Full Text] [PDF]
|
|
|
|
|
|
R Meijer, D S Ihnenfeldt, I J. de Groot, J van Limbeek, M Vermeulen, and R J de Haan Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature Clinical Rehabilitation, February 1, 2003; 17(2): 119 - 129. [Abstract] [PDF]
|
|
|
|
|
|
A.K. Gilligan, R. Markus, S. Read, V. Srikanth, T. Hirano, G. Fitt, M. Arends, B.R. Chambers, S.M. Davis, and G.A. Donnan Baseline Blood Pressure but Not Early Computed Tomography Changes Predicts Major Hemorrhage After Streptokinase in Acute Ischemic Stroke Stroke, September 1, 2002; 33(9): 2236 - 2242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. A. Molina, J. Alvarez-Sabin, J. Montaner, S. Abilleira, J. F. Arenillas, P. Coscojuela, F. Romero, and A. Codina Thrombolysis-Related Hemorrhagic Infarction: A Marker of Early Reperfusion, Reduced Infarct Size, and Improved Outcome in Patients With Proximal Middle Cerebral Artery Occlusion Stroke, June 1, 2002; 33(6): 1551 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Nighoghossian, M. Hermier, P. Adeleine, K. Blanc-Lasserre, L. Derex, J. Honnorat, F. Philippeau, J.F. Dugor, J.C. Froment, and P. Trouillas Old Microbleeds Are a Potential Risk Factor for Cerebral Bleeding After Ischemic Stroke: A Gradient-Echo T2*-Weighted Brain MRI Study Stroke, March 1, 2002; 33(3): 735 - 742. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. H.S. Leung, W.S. Poon, L.M. Yu, G. K.C. Wong, and H.K. Ng Apolipoprotein E Genotype and Outcome in Aneurysmal Subarachnoid Hemorrhage Stroke, February 1, 2002; 33(2): 548 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Prediction of Hemorrhagic Transformation Following Acute Stroke: Role of Diffusion- and Perfusion-Weighted Magnetic Resonance Imaging Arch Neurol, April 1, 2001; 58(4): 587 - 593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Fujii, S. Takeuchi, A. Harada, H. Abe, O. Sasaki, and R. Tanaka Hemostatic Activation in Spontaneous Intracerebral Hemorrhage Stroke, April 1, 2001; 32(4): 883 - 890. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. C. Tong, A. Adami, M. E. Moseley, and M. P. Marks Relationship Between Apparent Diffusion Coefficient and Subsequent Hemorrhagic Transformation Following Acute Ischemic Stroke Stroke, October 1, 2000; 31(10): 2378 - 2384. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Candelise, A. Ciccone, C. Motto, M. Fiorelli, R. v. Kummer, S. Bastianello, and L. Bozzao Extraparenchymal Bleeding Predicts an Unfavorable Outcome in Patients With Hemorrhagic Transformation Response Stroke, July 1, 2000; 31(7): 1785 - 1790. [Full Text] [PDF]
|
|
|
|
 |
|
 Anticoagulation and Stroke: More Data from MAST-I Journal Watch Neurology, July 1, 1999; 1999(701): 5 - 5. [Full Text]
|
|