Factors influencing hemorrhagic transformation in ischemic stroke: a clinicopathological comparison

Kerényi, Levente; Kardos, Lászĺo; Szász, József Attila; Szatmári, Szabolcs; Bereczki, Dániel; Hegedüs, Katalin; Csiba, László

doi:10.1111/j.1468-1331.2006.01489.x

Cited by 61 publications

(52 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Furthermore, diagnostic possibilities are often different in the routine practice as compared to well-defined and sponsored studies which last for a particular period of time. Moreover, ischaemic stroke patients usually have days or weeks [8,19] (in our sample 11.71 days, SD 13.16) before death with reduced level of consciousness and critical medical status. Therefore, the premortal diagnosis of haemorrhagic transformations could only be possible with daily repeat CT or MRI during the critically ill period, which is not possible either from the ethical or the financial point of view.…”

Section: Discussionmentioning

confidence: 87%

“…Additionally, the results of the clinical and neuropathological diagnostic tools are heterogenous, difficult to compare them, and the population examined can make it even more heterogenous due to the fact that autopsy results can be gained from fatal cases exclusively. Kerényi et al analysed an autopsy series of 245 patients with ischaemic stroke with haemorrhagic transformation in 29% [8]. Lodder et al reported an autopsy series with 48 patients dying within 15 days following a supratentorial cerebral infarct.…”

Section: Discussionmentioning

confidence: 99%

“…However it is well established that HT is not necessarily accompanied by deterioration of neurological status [7][8][9][10]. Fiorelli et al reported that only parenchymal haematoma type 2 was associated with an increased risk of clinical worsening (at 24 h after stroke onset) and of death (at 3 months); all other types of haematomas did not independently increase the risk of late deterioration [7].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have focused on the possible aetiological role of the following parameters: age [8,10,11,13,14], systolic and diastolic arterial blood pressure [14,15], congestive heart failure [11], body temperature [15], serum glucose level [8,14], treatment with anticoagulants [10,15], pre-treatment with aspirin [10,11], early ischaemic signs on CT [11,13,15], mean infarct volume [10,11,15], plasma matrix metalloproteinase-9 [15]. The adequate time window for detection of haemorrhagic transformation is also disputed [16] and autopsy is the method which provides the most accurate diagnosis in stroke.…”

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

“…Haemorrhagic infarction is a frequent complication of ischaemic stroke [6][7][8], although it is not always accompanied by clinical deterioration [7][8][9][10]. The effect on clinical outcome is also unclear and most of the literature data regained from studies on thrombolysis for…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Szepesi

Csokonay

Murnyák

et al. 2016

Journal of the Neurological Sciences

View full text Add to dashboard Cite

ObjectivesThe vast majority of literature on the frequency of the haemorrhagic transformation of ischaemic stroke is based on imaging studies. The purpose of the present study was to assess the added value of autopsy and neuropathological analysis in a neurology centre with emphasis on acute stroke care. MethodsWe retrospectively analysed the findings of 100 consecutive brain autopsies followed by detailed clinical correlation. ResultsThe clinical diagnosis was confirmed by neuropathology in every patient with intracerebral haemorrhage and with non-cerebrovascular neurological disorders (e.g. primary tumours, metastases, infections). At admission 64 patients (age 62 years, SD 6.5) were diagnosed with acute ischaemic stroke. In 10 of these patients (16%) haemorrhagic transformation was diagnosed clinically by a second CT. In 24 cases (38%) haemorrhagic transformation was detected only at autopsy. The distribution of haemorrhagic transformation in our material was the following: small petechiae in 26.5%, more confluent petechiae in 29.4%, ≤ 30% of the infarcted area with some mild space-occupying effect in 29.4% and > 30% of the infarcted area with significant space-occupying effect or clot remote from infarcted area in 14.7%. Most of the PH1-2 transformations developed in thrombolysed patients and all of the PH2 type transformations were diagnosed already clinically. ConclusionsWe demonstrated that haemorrhagic transformation is frequent and often undiscovered in vivo. Our findings underline the importance of post-mortem neuropathological examination also in the era of advanced imaging techniques and prove that autopsy is the ultimate yardstick of our diagnostic and therapeutic efforts. The high number of haemorrhagic transformations diagnosed only after death is an important novel finding with clinical implications.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: U N C O R R E C T E D P R O O Fmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Szepesi

Csokonay

Murnyák

et al. 2016

Journal of the Neurological Sciences

View full text Add to dashboard Cite

show abstract

Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas

Kunte

Busch

Trostdorf

et al. 2012

Annals of Neurology

View full text Add to dashboard Cite

Objective Disability or death occurs more frequently in patients with hemorrhagic transformation (HT) after ischemic stroke. In rat models of stroke, sulfonylurea (SU) drugs such as glibenclamide (adopted US name, glyburide) confer protection against swelling and HT through actions on the novel SUR1-regulated NCCa-ATP channel. Here, we sought to determine whether the use of SU drugs in patients with diabetes mellitus (DM) presenting with acute ischemic stroke might influence the incidence of HT. Methods We retrospectively analyzed data on 220 patients with DM who presented with acute ischemic stroke, 43 of whom were managed with and continued to receive SU drugs, and 177 of whom were managed without (controls). Results During a median length of stay in hospital of 11 days, 20 control patients (11%) experienced symptomatic HT (sHT), while no patient in the SU group experienced sHT (P=0.016). No patient in the SU group died, compared to 18 (10%) in the control group (P=0.027). Similarly favorable outcomes were observed after matching for baseline imbalances and excluding outliers. In support of the proposed mechanism, we present a case of sHT in which an analysis of brain tissues obtained intraoperatively showed prominent upregulation of SUR1, the target of SU drugs, in microvessels and neurons. Interpretation We conclude that, in diabetic patients with acute ischemic stroke, prior and continued use of SU drugs is associated with reduced sHT compared to those whose treatment regimen does not include SU drugs.

show abstract

Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes

et al. 2019

View full text Add to dashboard Cite

ObjectivesWe performed this retrospective cohort study to establish which factors are mostly indicative of the appearance of hemorrhagic transformation (HT) and of its time course in a sample of nonlacunar ischemic strokes.Materials and MethodsIn 402 patients with nonlacunar ischemic stroke (75.0 ± 12.7 years, 192 male), clinical, laboratory, and neuroimaging variables obtained during the first 3 days of hospitalization were compared between patients with and without HT at computer tomography scan.ResultsHT was documented in 129 patients (32.1%), including 36 with parenchymal hematoma (PH), after a median time of 6 days (range 1–27). Many variables were univariately associated with HT, but only 5 of them were confirmed in Cox regression (Hazard Ratio, 95% Confidence Interval): maximum cerebral lesion diameter (CLD) in cm (1.12, 1.06–1.18; p = .0001), hemoglobin in g/dl (1.16, 1.06–1.27; p = .002), blood glucose in mmol/L (1.10, 1.03–1.18; p = .007), prior anticoagulant therapy (1.82, 1.10–3.03; p = .02), and edema with mass effect (1.72, 1.08–2.75; p = .02). Thus, the most significant predictor was CLD. The overall risk of HT was minimum for CLD < 2 cm (1.5%), intermediate for CLD ≥ 2 and < 5 cm (22%), and maximum for CLD ≥ 5 cm (58%). The residual probability of having HT decreased progressively over time, and a simple formula is proposed to predict, from CLD in cm, when the probability of HT falls below 10%.ConclusionsThe main determinant of HT was CLD, a simple quantitative parameter that could prove useful, in particular, in deciding the timing of anticoagulation in cardioembolic stroke patients.

show abstract

Factors influencing hemorrhagic transformation in ischemic stroke: a clinicopathological comparison

Cited by 61 publications

References 28 publications

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Hemorrhagic transformation of ischemic stroke in diabetics on sulfonylureas

Predicting hemorrhagic transformation and its timing from maximum cerebral lesion diameter in nonlacunar ischemic strokes

Contact Info

Product

Resources

About