Hemorrhagic Transformation in Stroke Patients

Bayramoğlu, Meral; Karataş, Metin; Leblebici, Berrin; Çetin, Nuri; Sözay, Seyhan; Turhan, Nur

doi:10.1097/00002060-200301000-00008

Cited by 23 publications

(19 citation statements)

References 16 publications

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“…A recent study found that hemorrhagic transformation in stroke patients was detected in one third of patients admitted to acute rehabilitation, but functional outcome was not significantly different from that of patients who did not have hemorrhagic transformation on the first CT scan. 728 Hemorrhagic conversion in patients with cerebellar infarct significantly increased the risk of deterioration. 729 Recently, it has been suggested that gadolinium enhancement on T1-weighted MR images is predictive of hemorrhagic transformation, but this finding is unconfirmed.…”

Section: B Hemorrhagic Transformationmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams¹,

Zoppo²,

Alberts³

et al. 2007

Circulation

1,063

745

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Key Words: AHA Scientific Statements Ⅲ emergency medical services Ⅲ stroke Ⅲ acute cerebral infarction Ⅲ tissue plasminogen activator †Deceased. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Methods-Members

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Section: B Hemorrhagic Transformationmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams¹,

Zoppo²,

Alberts³

et al. 2007

Circulation

1,063

745

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“…Evacuation of a large hemorrhage may be lifesaving, whereas smaller hematomas may be tolerated without clinical relevance. 999 As with cerebral edema, cerebellar hemorrhagic conversion is more likely to become symptomatic.…”

Section: Hemorrhagic Transformationmentioning

confidence: 99%

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Jauch¹,

Saver²,

Adams³

et al. 2013

Stroke

5,372

1,801

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Background and Purpose-The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods-Members of the writing committee were appointed by the American Stroke Association Stroke Council's Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council's Level of Evidence grading algorithm. Results-The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Guidelines for the Early Management of PatientsThis statement was approved by the American Heart Association Science Advisory and Coordinating Committee on December 12, 2012. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.The Executive Summary is available as an online-only Data Supplement with this article at http://stroke.ahajournals.org/lookup/suppl/ doi:10.1161/STR.0b013e318284056a/-/DC1.The American Heart Association requests that this document be cited as follows: Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; on behalf of the American Heart Association Stroke Council, Council on Cardio...

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“…Many believe that so-called hemorrhagic transformations are part of the natural history of acute ischemic stroke and are clinically innocuous, a "CT scan event" without any adverse sequela. 3,4 Indeed, several studies have been unable to detect any effect on overall prognosis once other factors associated with a poor prognosis are accounted for. 4 -6 However, previous studies have had several important limitations, including relatively small samples and the absence of any power calculations.…”

mentioning

confidence: 99%

In Acute Ischemic Stroke, Are Asymptomatic Intracranial Hemorrhages Clinically Innocuous?

Kent

Hinchey

Price

et al. 2004

Stroke

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Background-In patients with acute ischemic stroke, intracranial hemorrhages are categorized as symptomatic or asymptomatic based on the presence or absence of a clinically detectable neurological deterioration. Asymptomatic intracranial hemorrhages are believed by many to be clinically innocuous. We examined whether the occurrence of an asymptomatic intracranial hemorrhage affects functional outcome in patients with acute ischemic stroke (AIS) treated or not treated with recombinant tissue plasminogen activator (rt-PA). Methods-We combined data from the NINDS rt-PA Stroke Trial and the ATLANTIS Trials, excluding patients with symptomatic intracranial hemorrhage (nϭ1193). We used generalized estimating equations to test whether asymptomatic intracranial hemorrhage altered the likelihood of a normal or near-normal outcome at 90 days, as measured across 4 commonly used functional outcome scales, controlling for other variables that affect outcome. To look at additional outcomes, including the likelihood of disability and death, we used logistic regression equations. Additionally, we systematically reviewed previous studies that assessed the effect of intracranial hemorrhage in AIS. Results-In the combined database, the rate of asymptomatic intracranial hemorrhage was higher in rt-PA treated than in nontreated patients (9.9% versus 4.2%, PϽ0.0001). Controlling for other prognostic factors, the odds of a normal or near-normal outcome was lower when a patient had an asymptomatic intracranial hemorrhage, but this effect did not reach statistical significance (ORϭ0.69, 95% CI: 0.43 to 1.12, Pϭ0.13). Similarly, the odds of not being moderately to severely disabled (modified Rankin Score Յ2) was also lower for patients with asymptomatic intracranial hemorrhage (ORϭ0.60, 95% CI: 0.33 to 1.08, Pϭ0.09). Despite using a larger sample than any previously published study, the power in our study to detect a 30% decrease in the odds of a good outcome was inadequate (Ϸ32%). Conclusion-We could not confirm or exclude a clinically significant effect for asymptomatic intracranial hemorrhages based either on our analysis or on any previously published trial. Analysis of substantially larger databases are needed to assess the import of this common clinical event.

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Hemorrhagic Transformation in Stroke Patients

Cited by 23 publications

References 16 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Patients With Acute Ischemic Stroke

In Acute Ischemic Stroke, Are Asymptomatic Intracranial Hemorrhages Clinically Innocuous?

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