Clinical and Lesion Related Features in Acute Cerebral Infarcts which have Hemorrhagic Transformation

Abstract

A hemorrhagic infarct (HI) has been defined as hemorrhagic transformation withrestoration of blood flow into a tromboembolic area. This study was planned to evaluateclinical profile in the patients with HI and the clinical and radiological features inhemorrhagic transformation. 34 patients who were admitted to our clinic within 7 daysafter stroke onset with HI in their first or control CT were evaluated. The features of these patients were compared with 15 patients who had not hemorrhagic transformation on their CT within 15 days. Hemorrhagic infarcts on CT were grouped as petechial and intra infarct hematoma formation and the group with hematoma was compared to other group for clinical features, infarct size, location, and arterial territory were noted on CT and these features were evaluated between groups. There was no difference between 34 patients with HI (mean age 59,08±15,44) and 15 patients with infarct (mean age 63,80±10,25) for age. Infarct size on CT was significantly larger in the patients with HI than the group who had not hemorrhagic transformation (p =0,001). Systolic blood pressure was similar in two groups while diastolic blood pressure was higher in the control group (p=0,036). The rate of presence of diabetes mellitus and hypertension was not different. Lipid profile and routine hematological parameters were also not different for two groups. The rate of seizure occurrence in the onset of stroke was not different whereas additional neurologic deficits were higher in the patients with HI. The percentage of the use of anticoagulant and antiaggregans were 44,1 % for stroke management. Non of the patients was on anticoagulant or antiaggregant treatment before stroke onset. Atrial fibrillation in 58, 8%, ischemia in 17,6%, left ventricular hypertrophy in 2,9% of the patients with HI were found with EKG. 23,5% valvular disease , 2,9% ventricular dilatation, 18,8% hypokinesia, 14,3% left ventricle hypertrophy were found with ECHO. ECHO was normal in 14,7% of the patients. Arterial territories which include HI were MCA in 76,5%, ACA in 2,9%, PCA in 2,9% multiple in 17, 7% of the patients with HI. Forıııs of His were intrainfarct hematoma in 50%, petechial in 47,1 % and mixed form in 2,9% of the patients. Among the patients withHI who had developed stroke within minutes were the most crowded group (55,9%). Thiswere followed by occurrence within hours (17,6%) and within days (8,8%) . The patientswith HI who had hematoma formation were not different for blood pressure, hematological parameters, lesion size and clinical features than the patients with petechial hemorrhages. There was not any difference for disability for two groups on the Rankin scale. In conclusion, we thought that cardiac sources are most important factor in hemorrhagic transformation and the duration of stroke development and infarct size can be predictors in hemorrbagic transformation. Other clinical features are not related to the occurrence of this transformation.