Enhancement of cerebral infarcts with CT

Caillé, J. M.; Guibert, F.; Bidabé, A.M.; Billerey, J.; Piton, J

doi:10.1016/0363-8235(80)90001-0

Cited by 29 publications

(7 citation statements)

References 13 publications

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“…We suggest that the value of the outcome of autopsy studies should be reconsidered in deciding whether stroke patients, in whom anticoagulant treatment is indicated, should receive such therapy or not. The present data and earlier studies (13,14,15,16,17,18,19) suggest that CT findings are far more relevant in this respect, and these show HI in only a small number of patients. However, since it is not excluded that anticoagulant treatment turns an HI into a frank hematoma, we suggest that patients with HI on CT should not receive such treatment as long as HI is present.…”

Section: Discussionsupporting

confidence: 69%

“…Patients without SM and HI have a better prognosis and will consequently not be considered in autopsy series. Therefore, pathologic studies are probably biased in finding a high number of HI, especially in embolic stroke, and they do not reflect the prevalence of HI during life, which is much lower as indicated by the present data and other studies (13,14,15,16,17,18,19). Our data also show that the number of patients with cardiac embolic stroke in the HI group did not differ from the control group indicating that cardiac embolism cannot be inferred from the presence of HI on CT as we showed before (18).…”

Section: Discussioncontrasting

confidence: 67%

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CT-detected hemorrhagic infarction; relation with the size of the infarct, and the presence of midline shift

Lodder

2009

Acta Neurologica Scandinavica

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The incidence of mass effect indicated by midline shift, and the incidence of hemorrhagic infarction were studied in 952 consecutive CT scans with supratentorial infarcts. Hemorrhagic infarction was found in 5.1 % indicating that the incidence of hemorrhagic infarction during life is far less than was suggested from pathological studies. Midline shift was found in 3.6% and, accordingly, the chance of finding a hemorrhagic infarct with mass effect indicated by a shift of the midline would be 0.2% if these 2 phenomena were not related. However, this incidence appeared to be 12 times higher, indicating they are closely related. In addition, the incidence of hemorrhagic infarcts and midline shift were both related to large infarcts with bad outcome. Cardiac emboli were not more prevalent in patients with hemorrhagic infarcts than in a control series, indicating that cardiac emboli do not produce hemorrhagic infarction more often than other causes of cerebral infarction, and that cardiac embolic cause cannot be inferred from hemorrhagic infarction on CT. This probably also applies to carotid emboli. When anticoagulation is considered in patients with cerebral infarction, CT-confirmed hemorrhagic infarction and shift of midline structures as well as decreased consciousness are contraindications to such treatment. In their absence, and in the absence of general contraindications, anticoagulant treatment can safely be started.

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Section: Discussionsupporting

confidence: 69%

Section: Discussioncontrasting

confidence: 67%

CT-detected hemorrhagic infarction; relation with the size of the infarct, and the presence of midline shift

Lodder

2009

Acta Neurologica Scandinavica

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“…[20][21][22][23] This contrasts with the findings in pathology series in which in about two thirds of the cases with embolic stroke HI was found. 6 ' 7 This could be explained by a possible bias in pathology series, especially when death is primarily caused by structural brain impairment in cases with brain herniation.…”

Section: Discussioncontrasting

confidence: 50%

“…[8][9][10] Therefore, some clinicians feared aggravation of the neurological deficit by inducing hemorrhage into ischemic brain areas in patients with embolic stroke, 3 " -17 although the few available clinical studies lent no support to this view. 18,19 Since hemorrhagic infarction is seldom seen on CT [20][21][22] even in cases with embolic stroke, 23 we assumed that clinical findings differ from the outcome of pathology and experimental studies. Therefore we prospectively studied the risk of early anticoagulant treatment (started within 24 hours after the embolic stroke) during the early phase (three weeks) in patients with an embolic stroke.…”

mentioning

confidence: 99%

Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin.

Lodder¹,

Lugt²

1983

Stroke

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We evaluated immediate anticoagulation of embolic stroke. Of 39 patients suffering a focal cerebral ischemia caused by a cardiac embolus, 38 were submitted to CT within 24 hours after onset. Twenty-one patients received direct full anticoagulation and, in 10 patients, treatment was delayed because of hemorrhagic infarction on initial CT (3 cases), cardiac cause 24 hours or more after stroke onset, or treatment delay without specific reason (6 cases). Eight patients with severe deficit were not anticoagulated because of hemorrhagic signs on initial CT, impaired consciousness, or general contra-indications to such treatment. Twenty-one follow-up CT-scans were performed under full anti-coagulation, and in only 2 cases hemorrhagic infarction was noticed without clinical deterioration. No clinical worsening attributable to anticoagulant treatment was observed during the three week observation period. It is concluded that direct anticoagulation therapy does neither induce hemorrhagic infarction nor cerebral hemorrhage in patients with embolic stroke nor does it cause clinical deterioration.

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“…[21][22][23] It is rarely seen within the first week but may be observed in 60 to 70% of patients by 2 to 4 weeks after the acute event. 23,24 It is also seen more commonly with larger infarcts and infarcts with mass effect, possibly accounting for the observed poor prognosis of enhancing lesions. 22 Possibly patients with stroke and no ischemic lesions on CT are a favorable selection for early surgery.…”

Section: Discussionmentioning

confidence: 99%

Early Carotid Surgery for Recent Neurologic Deficit

Schunn¹,

Hetzel²,

Lange³

et al. 2000

Perspectives in Vascular Surgery

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Early carotid endarterectomy after recent neurologic deficit is controversial. Traditionally, an interval of at least 4 to 6 weeks has been recommended based on poor historical results of early surgical intervention after recent strokes and fear of hemorrhagic transformation of the infarct. On the other hand, recurrent strokes have been observed in up to 9.5% of patients while awaiting carotid repair. Since 1996 we have adopted a more aggressive approach to a highly selected group of patients with fresh ischemic deficits, prolonged reversible ischemic neurologic deficit (PRIND), or crescendo transient ischemic attacks (TIAs). Of 2824 patients who underwent carotid endarterectomy between August 1996 and December 1998, 112 patients (3.9%) underwent 123 carotid operations within less than 30 days (median interval: 8 days) after a nondisabling stroke, PRIND, or TIA. Postoperatively five patients (4.4%) suffered a stroke, one patient a transient worsening of his preoperative deficit, and one patient a TIA. Six patients died, three of which were due to their stroke (mortality 5.3%). One of these fatal strokes was due to an intracerebral hemorrhage in a patient with normal preoperative computed tomography. The combined 30-day permanent neurologic stroke and death rate was 7.1%. Functional neurologic outcome was excellent with 74.1% of patients suffering no or minimal deficit (Rankin scale 0-1). Patients with unstable or progressing neurologic deficit were found to have a significantly increased postoperative stroke rate (25%). Early carotid endarterectomy after nondisabling neurologic deficit may be performed with acceptable risk in carefully selected patients. The benefit of early versus delayed surgery, however, can only be determined in a prospective randomized study. 95

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Enhancement of cerebral infarcts with CT

Cited by 29 publications

References 13 publications

CT-detected hemorrhagic infarction; relation with the size of the infarct, and the presence of midline shift

CT-detected hemorrhagic infarction; relation with the size of the infarct, and the presence of midline shift

Evaluation of the risk of immediate anticoagulant treatment in patients with embolic stroke of cardiac origin.

Early Carotid Surgery for Recent Neurologic Deficit

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