CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction.

Abstract

Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eight-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. The CT findings of multiple intracranial bleeding sites, substantial mass effect with midline shift, and large-volume intraparenchymal hematomas were associated with increased mortality. ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization.

Thrombolysis-Related Intracranial Hemorrhage

“…Although the relationship of head trauma to SDH pathogenesis is well established, 13,34 the association observed in this study reinforces that any prior traumatic vascular lesion, even if clinically asymptomatic, is a risk factor for developing this high-volume, high-mortality lesion. This conclusion is cautiously made, however, since there is no way to account for whether bias in history taking existed for this subgroup.…”

“…5,[13][14][15] Age, hypertension, low body weight, and elevated fibrin degradation products have been identified as clinical risk factors, and amyloid angiopathy, hypertensive vascular disease, and hemorrhagic transformation of a prior silent cerebral infarct have been reported as underlying neuropathologic causes. [15][16][17][18][19] The studies from which these reports are based, however, are seriously limited by small case series, lack of consistent clinical or neuroimaging documentation of cerebrovascular complications, and uncommon use of more than one thrombolytic regimen.…”

Post-thrombolysis intracerebral hemorrhage: Data from the Spanish Register ARIAM*

“…ICH complications result in a high mortality rate, high financial costs, and a worse quality of life for surviving patients. The incidence of ICH ranges from the 0.22% noted in the GISSI study (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15) to 1.4% (16).…”

“…In any case, the results of this study in relation to age are similar to those obtained in most previous studies. Hypertension is a classic complication associated with the occurrence of ICH (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15).…”

Rupture of a thrombosed intracranial aneurysm during arterial thrombolysis

“…The true incidence of aneurysmal rupture as an adverse event of thrombolysis in ischemic stroke is unknown. Estimates of intracranial hemorrhages in terms of subarachnoid hemorrhage, possibly due to aneurysmal bleeding, or parenchymal hemorrhage are not available from stroke trials [3,4,9], but one review on thrombolysis in myocardial infarction revealed a subarachnoid hemorrhage in 24 % of those cases with intracranial bleedings [10].…”