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Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Hemorrhagic transformation of ischemic stroke occurs in about 10–15% of patients. The strongest predictor is the size of the infarct (e.g. AF patients), and less so, increasing BP and age. Two-thirds are petechial hemorrhages (often referred to as hemorrhagic infarction), and one-third are parenchymal hematomas (PHs).
Intracranial Hemorrhage (ICH)
Published in Swati Goyal, Neuroradiology, 2020
The spectrum of hemorrhagic infarcts may range from petechiae-like hemorrhages to frank parenchymal hematomas. Usually, hemorrhagic transformation of initially ischemic lesions occurs when an occluded vessel recanalizes and ischemic areas are reperfused, following embolus fragmentation and lysis.
Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
Early recognition of hemorrhagic transformation of a stroke is critical. It is a major complication of reperfusion therapy such as thrombolysis and tends to occur 12–24 hours following treatment. An initial CT brain scan is performed to diagnose stroke and may have involved contrast to assess related vessels. In the follow-up scan, differentiating acute hemorrhage from residual contrast from the initial scan, can pose a diagnostic challenge in single energy non-contrast CT. DECT can help accurately distinguish intraparenchymal hemorrhage from iodinated contrast medium, by means of iodine mapping (Gupta et al. 2010) (Figure 3.3).
Impact of cerebral microbleeds on cognitive functions and its risk factors in acute cerebral infarction patients
Published in Neurological Research, 2023
Linyun Chen, Feng Liu, Xuan Tian, Tian Zhang, Jian Zhang, Fang Ran
Cerebral infarction is a clinical condition in which the blood supply of intracranial vascular tissue is insufficient due to various reasons, which eventually leads to necrosis of brain tissue [16]. Patients with cerebral infarction will have symptoms such as dizziness, vomiting, nausea, tinnitus, hemiplegia, and even coma shock, which seriously affects the health and quality of life of the patients [17]. Acute cerebral infarction has the characteristics of rapid onset, rapid disease progression, and serious disease [18]. With the aging of the population, the incidence of acute cerebral infarction is increasing year by year, and it has become an important disease that threatens human life and health [19]. Cerebral microbleeds are caused by small blood vessel lesions in the brain, characterized by the deposition of hemosiderin around the small blood vessels or the phagocytosis of hemosiderin mononuclear cells, with a tendency to hemorrhage [20]. Studies have shown that the incidence of cerebral microbleeds in ACI patients is 53.54% [6,21]. The incidence and severity of cerebral microbleeds in patients with different types of cerebral infarction are different [22]. Hemorrhagic transformation is a common complication in patients with ACI [23].
The effect of hematoma evacuation with decompressive craniectomy on clinical outcomes in patients with parenchymal hematoma type 2 of hemorrhagic transformation after middle cerebral artery infarction
Published in Neurological Research, 2022
Hyeongcheol Oh, Sook Young Sim, Jin Young Choi, Yu-Shik Shim, Se-Yang Oh, Sang Kyu Park, Myeong Jin Kim, Yong Cheol Lim, Joonho Chung
Hemorrhagic transformation is one of the most common complications of ischemic stroke. The incidence of symptomatic hemorrhagic transformation varies and ranges from 6–12% [1,2]. Hemorrhagic transformation refers to a spectrum of ischemia-related brain hemorrhage and can be divided into hemorrhage infarction and parenchymal hematoma. On the radiologic images, hemorrhagic infarction is a heterogeneous hyperdensity occupying a portion of an ischemic infarct without mass effect, whereas parenchymal hematoma refers to a more homogeneous, sharply defined dense hematoma combined with or without mass effect. Among them, parenchymal hematoma type 2 (PH2), homogeneous hyperdensity occupying > 30% of the infarct zone with significant mass effect, independently causes clinical deterioration and impairs prognosis [1,3–5].
Factors associated with early improvement after intravenous thrombolytic treatment in acute ischemic stroke
Published in Neurological Research, 2022
Nurcan Akbulut, Vesile Ozturk, Suleyman Men, Atakan Arslan, Zeynep Tuncer Issı, Erdem Yaka, Kursad Kutluk
The twenty-fourth hour after stroke is clinically important. This is because, from a prognostic point of view, many clinical and radiological variables that are relevant to acute ischemic stroke can be obtained at or after 24 hours from admission. Patients who receive IV rt-PA are typically subjected to brain imaging 24 hours later to exclude hemorrhagic transformation. The risk of hemorrhagic transformation decreases after 24 hours, and rapid clinical improvement or early neurological deterioration becomes clear at this point in time [39]. In addition, prognostic evaluation and treatment decisions are usually made after the first 24 hours [52]. Although ENI at the twenty-fourth hour is mostly evaluated in the studies, the very early period, specifically the findings in the first hour and second hour, can also be used together with seventh day ENI. Although early improvement can be observed in the first hour hyperacute phase, this improvement may also be attributed to reasons other than stroke. In our study, the improvement at the twenty-fourth hour and on the seventh day correlated with each other, and a statistically significant relationship was detected with the positive functional outcome in the long term. This result supports the idea that it is appropriate to evaluate the findings at the twenty-fourth hour and on the seventh day instead of the first hour for ENI.