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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